Basic Information
| Provider Information | |||||||||
| NPI: | 1437152451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 W TEMPLE AVE STE 2500 | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175402350 | ||||||||
| FaxNumber: | 2173472323 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W TEMPLE AVE STE 2500 | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175402350 | ||||||||
| FaxNumber: | 2173472323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 36509 | MO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 43803 | 01 | CMR | OTHER | 4441V6097 | 01 | HEALTHCARE USA | OTHER | 9045 | 01 | EXCLUSIVE CHOICE | OTHER | 23266 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | 900096 | 01 | UHC | OTHER | SP11098 | 01 | CIGNA | OTHER | 2819V3458 | 01 | GHP/ADVANTRA | OTHER | 108839 | 01 | HEALTHLINK | OTHER | 4061206 | 01 | AETNA | OTHER |