Willis, Jerrold C
Willis, Jerrold C is an individual health care provider with primary practice located at 1 Good Samaritan Way Radiology Dept, Mount Vernon IL 62864-2402. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Willis, Jerrold C can be contacted via phone (618) 242-4600.Contact Information
Primary practice address
1 Good Samaritan Way Radiology Dept
Mount Vernon IL 62864-2402
Phone: (618) 242-4600
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 36057038 | Illinois |
Profile Details
| NPI number | 1467407072 |
|---|---|
| LBN Legal business name | Willis, Jerrold C |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 23rd, 2006 |
| Last updated | Mar 15th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467407072 | NPPES |
| Illinois | Other | 300119485 | RAILROAD ST JOES/UTLAH |
| Illinois | Other | 300117217 | RAILROAD ST JOES/UTLAH |
| Illinois | MEDICAID | 036057038-3 | RAILROAD ST JOES/UTLAH |
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