| Vine St Clinic | |
|
3225 Hedley Rd Springfield IL 62711-6248 | |
| (217) 726-7300 | |
| (217) 726-5989 |
| Full Name | Vine St Clinic |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 3225 Hedley Rd, Springfield, Illinois |
| Authorized Official Name and Position | Richard B Alexander (PARTNER) |
| Authorized Official Contact | 2177267300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vine St Clinic 3225 Hedley Rd Po Box 13484 Springfield IL 62711-6248 Ph: (217) 726-7300 | Vine St Clinic 3225 Hedley Rd Springfield IL 62711-6248 Ph: (217) 726-7300 |
| NPI Number | 1730217662 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 04/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730217662 | NPI | - | NPPES |
| CL5057 | Other | GA | RAILROAD MEDICARE |
| 08415473 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Secondary |
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