Provider Demographics
NPI:1194718742
Name:JOSEPHINE N. MCCASKILL
Entity type:Organization
Organization Name:JOSEPHINE N. MCCASKILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:773-640-7944
Mailing Address - Street 1:3153 E BENDING CREEK TRL
Mailing Address - Street 2:PO BOX 545
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-3861
Mailing Address - Country:US
Mailing Address - Phone:773-640-7944
Mailing Address - Fax:
Practice Address - Street 1:3153 E BENDING CREEK TRL
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-3861
Practice Address - Country:US
Practice Address - Phone:773-640-7944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004940261Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid
ILQ43369Medicare UPIN