Dr George R Grant, MD | |
1000 Health Center Drive, Mattoon, IL 61938-0372 | |
(217) 258-2551 | |
(217) 258-2256 |
Full Name | Dr George R Grant |
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Gender | Male |
Speciality | Emergency Medicine |
Location | 1000 Health Center Drive, Mattoon, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1376565788 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | 2001022239 (Missouri) | Primary |
Entity Name | Salem Township Hospital |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1295739548 PECOS PAC ID: 0840195277 Enrollment ID: O20031126000688 |
Entity Name | Pinckneyville Community Hospital |
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Entity Type | Part A Provider - Critical Access Hospital |
Entity Identifiers | NPI Number: 1689646523 PECOS PAC ID: 8123921632 Enrollment ID: O20080506000051 |
Entity Name | Midwest Emergency Good Samaritan, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1629367578 PECOS PAC ID: 1658529342 Enrollment ID: O20120921000645 |
Entity Name | Midwest Emergency Centralia Campus Associates, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1396034245 PECOS PAC ID: 2163672650 Enrollment ID: O20121018000074 |
Entity Name | Integritas Emergency Physician Services Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1790128817 PECOS PAC ID: 7113167446 Enrollment ID: O20130710000760 |
Mailing Address | Practice Location Address |
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Dr George R Grant, MD 320 E Highway 50, O Fallon, IL 62269-2704 Ph: (618) 624-3368 | Dr George R Grant, MD 1000 Health Center Drive, Mattoon, IL 61938-0372 Ph: (217) 258-2551 |
Joseph Burton, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1000 Health Center Dr, Mattoon, IL 61938 Phone: 217-258-2551 | |
Dwight Pentzien, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1000 Health Center Dr, Mattoon, IL 61938 Phone: 217-258-2551 Fax: 217-258-2256 | |
Aja Lystila, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 2512 Hurst Dr., Family Medicine, Mattoon, IL 61938 Phone: 217-258-5900 Fax: 217-258-5904 | |
Daniel Bommelje, D.O. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1000 Health Center Dr, Mattoon, IL 61938 Phone: 217-258-2551 Fax: 217-258-2256 | |
Dionte Wiggins, Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1000 Health Center Dr, Mattoon, IL 61938 Phone: 217-258-2551 Fax: 217-258-2256 | |
Lori Luther, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1000 Health Center Dr, Mattoon, IL 61938 Phone: 217-258-2551 Fax: 217-258-2256 | |
Shane Cline, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1000 Health Center Dr, Mattoon, IL 61938 Phone: 217-258-2551 |