| |
101 N Walnut St, Pinckneyville, IL 62274-1034 | |
(618) 357-2187 | |
(618) 357-3165 |
Full Name | |
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Type | Facility |
Speciality | Podiatrist - Foot & Ankle Surgery |
Location | 101 N Walnut St, Pinckneyville, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1255344941 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213ES0103X | Podiatrist - Foot & Ankle Surgery | 016005263 (Illinois) | Primary |
Mailing Address | Practice Location Address |
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1299 Reavis Barracks Rd, Saint Louis, MO 63125-3260 Ph: (314) 487-9300 | 101 N Walnut St, Pinckneyville, IL 62274-1034 Ph: (618) 357-2187 |