| Central Illinois Oral Surgery | |
|
1200 Network Centre Dr Suite B Effingham IL 62401-4637 | |
| (217) 540-5800 | |
| (217) 342-2557 |
| Full Name | Central Illinois Oral Surgery |
|---|---|
| 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 |
|---|---|
| Central Illinois Oral Surgery 1200 Network Centre Dr Suite B Effingham IL 62401-4637 Ph: (217) 540-5800 | Central Illinois Oral Surgery 1200 Network Centre Dr Suite B Effingham IL 62401-4637 Ph: (217) 540-5800 |
| NPI Number | 1891843595 |
|---|---|
| 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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