| Ten Broeck Tennessee Physicians Group Inc | |
|
45oo Memorial Drive Belleville IL 62226-5399 | |
| (618) 257-5900 | |
| (618) 257-5463 |
| Full Name | Ten Broeck Tennessee Physicians Group Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 45oo Memorial Drive, Belleville, Illinois |
| Authorized Official Name and Position | Glenda F Guy (DIRECTOR, COMPLIANCE) |
| Authorized Official Contact | 9317832511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ten Broeck Tennessee Physicians Group Inc 1 Medical Center Blvd Cookeville TN 38501-4294 Ph: (931) 783-2511 | Ten Broeck Tennessee Physicians Group Inc 45oo Memorial Drive Belleville IL 62226-5399 Ph: (618) 257-5900 |
| NPI Number | 1275155418 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 05/11/2020 |
| Certification Date | 05/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275155418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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