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221 E County Rd Jerseyville IL 62052-3190 | |
| (618) 937-6483 | |
| (618) 937-1440 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 221 E County Rd, Jerseyville, Illinois |
| Authorized Official Name and Position | Stacy D Phillips (ACCOUNTS RECEIVABLES DEPARTMENT MAN) |
| Authorized Official Contact | 6189376483 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
902 W Main West Frankfort IL 62896-2210 Ph: (618) 937-6483 | 221 E County Rd Jerseyville IL 62052-3190 Ph: (618) 937-6483 |
| NPI Number | 1497064208 |
|---|---|
| Provider Enumeration Date | 09/28/2010 |
| Last Update Date | 11/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497064208 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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