| |
1200 Network Centre Dr Suite B Effingham IL 62401-4637 | |
(217) 540-5800 | |
(217) 342-2557 |
Full Name | |
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Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 1200 Network Centre Dr, Effingham, Illinois |
Authorized Official Name and Position | Amy Kroeger (INS COODINATOR) |
Authorized Official Contact | 2175405100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1200 Network Centre Dr Suite B Effingham IL 62401-4637 Ph: (217) 540-5800 | 1200 Network Centre Dr Suite B Effingham IL 62401-4637 Ph: (217) 540-5800 |
NPI Number | 1891843595 |
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Provider Enumeration Date | 01/08/2007 |
Last Update Date | 06/29/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891843595 | NPI | - | NPPES |
1014426 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | 019-024942 (Illinois) | Primary |
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