Basic Information
| Provider Information | |||||||||
| NPI: | 1306874466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCALLASTER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N MAPLE ST | ||||||||
| Address2: | P O BOX 1268 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173424151 | ||||||||
| FaxNumber: | 2173424190 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173424151 | ||||||||
| FaxNumber: | 2173424190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036123385 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2006012811 | MO | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036123385 | 05 | IL | MEDICAID | 1952304412 | 01 | IL | MARSHALL CLINIC EFFINGHAM, SC GROUP PRACTICE NPI | OTHER |