| Prairie Psychiatry, Sc | |
|
301 W Lincoln St Suite 106 Belleville IL 62220-1901 | |
| (618) 235-1582 | |
| (618) 235-2473 |
| Full Name | Prairie Psychiatry, Sc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 301 W Lincoln St, Belleville, Illinois |
| Authorized Official Name and Position | Randy John Jung (OWNER) |
| Authorized Official Contact | 6182351582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Psychiatry, Sc 301 W Lincoln St Suite 106 Belleville IL 62220-1901 Ph: (618) 235-1582 | Prairie Psychiatry, Sc 301 W Lincoln St Suite 106 Belleville IL 62220-1901 Ph: (618) 235-1582 |
| NPI Number | 1760563688 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4284714049 |
|---|---|
| Medicare Enrollment ID | O20080107000048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760563688 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Illinois) | Primary |
| Provider Name | Randy J Jung |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205917176 PECOS PAC ID: 5193805943 Enrollment ID: I20080107000040 |
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