| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1506 Sioux Dr, Marion, 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 |
|---|---|
109 California St Po Box 577 Carterville IL 62918 Ph: (618) 985-8221 | 1506 Sioux Dr Marion IL 62959-5209 Ph: (618) 519-9200 |
| NPI Number | 1043902752 |
|---|---|
| Provider Enumeration Date | 05/22/2023 |
| Last Update Date | 07/17/2024 |
| Certification Date | 07/17/2024 |
| Medicare PECOS PAC ID | 1658285671 |
|---|---|
| Medicare Enrollment ID | O20231005002169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043902752 | NPI | - | NPPES |
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