| Ten Broeck Tennessee Physicians Group Inc | |
|
530 Park Ave E Princeton IL 61356-3901 | |
| (815) 876-2004 | |
| (815) 876-2008 |
| Full Name | Ten Broeck Tennessee Physicians Group Inc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 530 Park Ave E, Princeton, Illinois |
| Authorized Official Name and Position | Karissa Hutson (BUSINESS OFFICE) |
| Authorized Official Contact | 9313194231 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ten Broeck Tennessee Physicians Group Inc 530 Park Ave E Princeton IL 61356-3901 Ph: (815) 876-2004 | Ten Broeck Tennessee Physicians Group Inc 530 Park Ave E Princeton IL 61356-3901 Ph: (815) 876-2004 |
| NPI Number | 1518543248 |
|---|---|
| Provider Enumeration Date | 03/23/2021 |
| Last Update Date | 03/23/2021 |
| Certification Date | 03/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518543248 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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Youth Service Bureau Of Illinois Valley Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1702 1/2 W Peru St, Princeton, IL 61356 Phone: 815-872-2119 Fax: 815-872-2099 | |
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