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15470 Lake Of Egypt Rd Creal Springs IL 62922-3731 | |
(618) 519-9200 | |
(618) 998-0880 |
Full Name | |
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Speciality | Clinic/Center |
Location | 15470 Lake Of Egypt Rd, Creal Springs, Illinois |
Authorized Official Name and Position | Christina Carney (CEO) |
Authorized Official Contact | 6189569521 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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109 California St Po Box 577 Carterville IL 62918 Ph: (618) 519-9200 | 15470 Lake Of Egypt Rd Creal Springs IL 62922-3731 Ph: (618) 519-9200 |
NPI Number | 1013620160 |
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Provider Enumeration Date | 01/04/2023 |
Last Update Date | 07/29/2024 |
Certification Date | 07/29/2024 |
Medicare PECOS PAC ID | 1658285671 |
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Medicare Enrollment ID | O20230830001809 |
Identifier | Type | State | Issuer |
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1013620160 | NPI | - | NPPES |