| Psychiatric Associates Of Central Illinois Ltd | |
|
1124 South Sixth Street Springfield IL 62703-0406 | |
| (217) 523-3143 | |
| (217) 523-7695 |
| Full Name | Psychiatric Associates Of Central Illinois Ltd |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1124 South Sixth Street, Springfield, Illinois |
| Authorized Official Name and Position | Cathy M Tomlin (OFFICE MANAGER) |
| Authorized Official Contact | 2175233143 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychiatric Associates Of Central Illinois Ltd 1124 South Sixth Street Springfield IL 62703-0406 Ph: (217) 523-3143 | Psychiatric Associates Of Central Illinois Ltd 1124 South Sixth Street Springfield IL 62703-0406 Ph: (217) 523-3143 |
| NPI Number | 1376698050 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1355318825 |
|---|---|
| Medicare Enrollment ID | O20040914000634 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376698050 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (Illinois) | Primary |
| 104100000X | Social Worker | (Illinois) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Illinois) | Primary |
| Provider Name | Brian F Heatherton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235152901 PECOS PAC ID: 0749252013 Enrollment ID: I20040807000149 |
| Provider Name | Juan M Medina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265485106 PECOS PAC ID: 1153351648 Enrollment ID: I20050815000651 |
| Provider Name | Julie M Tucker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447302583 PECOS PAC ID: 8022025659 Enrollment ID: I20081112000432 |
| Provider Name | Kimberly A Earl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063669497 PECOS PAC ID: 2567523541 Enrollment ID: I20081209000575 |
| Provider Name | Angela K Severado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952787376 PECOS PAC ID: 3779899943 Enrollment ID: I20150902001972 |
| Provider Name | Kimberley A Durr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093114290 PECOS PAC ID: 1052615325 Enrollment ID: I20160205002011 |
| Provider Name | Amy L Yeates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477911634 PECOS PAC ID: 1254612666 Enrollment ID: I20161223000224 |
| Provider Name | Molly J Hardwick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881012847 PECOS PAC ID: 6406131523 Enrollment ID: I20170331001457 |
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