| Nicole M Jack, PA-C | |
|
2500 W Reynolds St, Pontiac, IL 61764 | |
| (815) 844-5343 | |
| (815) 844-5715 |
| Full Name | Nicole M Jack |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Experience | 7 Years |
| Location | 2500 W Reynolds St, Pontiac, Illinois |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083104137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 085006579 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Memorial Medical Center | Springfield, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Memorial Physician Services | 9032005681 | 165 |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole M Jack, PA-C 2500 W Reynolds St, Pontiac, IL 61764-9774 Ph: (815) 844-5343 | Nicole M Jack, PA-C 2500 W Reynolds St, Pontiac, IL 61764 Ph: (815) 844-5343 |
William Lee Chang Ii, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2500 W Reynolds St, Pontiac, IL 61764 Phone: 815-844-4062 Fax: 815-844-4962 | |
Taggart Venegas, Physician Assistant Medicare: Medicare Enrolled Practice Location: 2500 W Reynolds St, Pontiac, IL 61764 Phone: 815-842-2828 | |
Leslie Romersberger, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2500 W Reynolds St, Pontiac, IL 61764 Phone: 815-844-5343 | |
Danielle Vanderveen, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2500 W Reynolds St, Pontiac, IL 61764 Phone: 815-844-6551 Fax: 815-842-1793 | |
Richard Saylor, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2500 W Reynolds St, Pontiac, IL 61764 Phone: 815-844-4062 Fax: 815-844-4962 | |
John Kincinas, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2500 W Reynolds St, Pontiac, IL 61764 Phone: 815-844-4062 Fax: 815-844-4962 |