Basic Information
| Provider Information | |||||||||
| NPI: | 1568636470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWCOMB | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 577 | ||||||||
| Address2: | |||||||||
| City: | CARTERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629180577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189858221 | ||||||||
| FaxNumber: | 6189856860 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S LEWIS LANE | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629013021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185199900 | ||||||||
| FaxNumber: | 6185199901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036119399 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10032052 | 01 | IL | BCBS | OTHER | 370966854005 | 05 | IL | MEDICAID | 640701 | 01 | IL | MEDICARE PART B GROUP NUMBER | OTHER | CF3444 | 01 | IL | MEDICARE RAILROAD | OTHER | 1639295314 | 01 | IL | SHAWNEE HEALTH SERVICE NP | OTHER | 370966854002 | 05 | IL | MEDICAID | 370966854006 | 05 | IL | MEDICAID |