| Doctor Name: | MR. JASON D CHURCHILL |
| NPI Number: | 1265592455 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | 2006030653 |
| Business Practice Address: | 510 Lincoln Dr Herrin, IL - 629486334 |
| Business Phone Number: | 6189974310 |
| Business Fax Number: | 6189989635 |
| Mailing Address: | 510 Lincoln Dr, HERRIN |
| State: | IL |
| Postal Code: | 629486334 |
| Phone Number: | 6189974310 |
| Fax Number: | 6189989635 |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 09/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 2006030653 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |