| Belleville Pediatric & Adolescent Health Center | |
|
2900 Frank Scott Pkwy W Suite 950 Belleville IL 62223-5000 | |
| (618) 233-3205 | |
| (618) 233-1407 |
| Full Name | Belleville Pediatric & Adolescent Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2900 Frank Scott Pkwy W, Belleville, Illinois |
| Authorized Official Name and Position | Larry Mcculley (CEO) |
| Authorized Official Contact | 6183320694 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Belleville Pediatric & Adolescent Health Center 2041 Goose Lake Rd Sauget IL 62206-2822 Ph: (618) 332-0953 | Belleville Pediatric & Adolescent Health Center 2900 Frank Scott Pkwy W Suite 950 Belleville IL 62223-5000 Ph: (618) 233-3205 |
| NPI Number | 1376588871 |
|---|---|
| Provider Enumeration Date | 06/18/2006 |
| Last Update Date | 08/08/2014 |
| Medicare PECOS PAC ID | 1456256874 |
|---|---|
| Medicare Enrollment ID | O20140820001464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376588871 | NPI | - | NPPES |
| 732740 | Other | IL | WPS MEDICARE |
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