Jody Hannah Lack
MD | Pediatrics | Female
Jody Hannah Lack, MD is a Springfield, Illinois based Pediatric doctor with medical specialization in
General Pediatrics.
Current practice location of Jody Hannah Lack is
415 N 9th St, Ste 4w64, Springfield, Illinois - 62702-5303. She can be contacted on phone at
217-545-0003 and fax number 217-545-7615.
Jody Hannah Lack is a sole proprietor of her business.
NPI number (Unique professional ID) for Jody Hannah Lack is
1235351818 which was assigned by NPPES on 03 May, 2007 and it was last updated on 13 Jan, 2011.
Jody Hannah Lack license number is
036-122811 for Pediatrics (208000000X) in Illinois.
Jody Hannah Lack is a pediatrician who is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Complete Profile:
Jody Hannah Lack basic information including her official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics |
|---|
| Provider Name : | Jody Hannah Lack |
|---|
| Credential : | MD |
|---|
| Gender : | Female |
|---|
Business Address:
Jody Hannah Lack address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 415 N 9th St, Ste 4w64
Springfield, IL, 62702-5303
United States |
|---|
| Phone Number : | 217-545-0003 |
|---|
| Fax Number : | 217-545-7615 |
|---|
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1235351818 |
|---|
| NPI Entity Type : | Individual |
|---|
| First Enrolment Date : | 03 May, 2007 |
|---|
| Last Updated On : | 13 Jan, 2011 |
|---|
Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Jody Hannah Lack are as mentioned. Primary taxonomy code for Jody Hannah Lack, MD is
208000000X (Pediatrics).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 208000000X | Pediatrics | Yes | 036-122811 | IL |
Legacy Identifiers:
Other legacy medical identifiers of Jody Hannah Lack such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 036122811 | MEDICAID | IL | |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | Po Box 19676
Springfield, IL, 62794-9676
United States |
|---|
| Phone Number : | 217-545-0003 |
|---|
| Fax Number : | 217-545-7615 |
|---|
Business Location:
Patients can refer following map for directions to
Jody Hannah Lack practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.