Provider Demographics
NPI:1316109283
Name:JUNCTION MEDICAL SC
Entity type:Organization
Organization Name:JUNCTION MEDICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JONGERIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-692-5487
Mailing Address - Street 1:447 E HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2213
Mailing Address - Country:US
Mailing Address - Phone:309-692-5487
Mailing Address - Fax:
Practice Address - Street 1:5016 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4781
Practice Address - Country:US
Practice Address - Phone:309-692-5487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty