Idol Ray Mitchell, DPM | |
437 East Grant Street, Macomb, IL 61455-3352 | |
(309) 837-3964 | |
(309) 837-3966 |
Full Name | Idol Ray Mitchell |
---|---|
Gender | Male |
Speciality | Podiatry |
Experience | 32 Years |
Location | 437 East Grant Street, Macomb, Illinois |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1508850694 | NPI | - | NPPES |
4452210001 | Other | DMERC | |
480034728 | Other | RAILROAD MEDICARE PROV # | |
016004683 | Medicaid | IL | |
214428 | Other | IL | MEDICARE ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 016-004683 (Illinois) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
Mc Donough District Hospital | Macomb, IL | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Blessing Hospital | 3072422534 | 349 |
Provider Name | Mcdonough County Hospital District |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1669420766 PECOS PAC ID: 0446140180 Enrollment ID: O20040611000228 |
Provider Name | Blessing Corporate Services Inc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1851311641 PECOS PAC ID: 5991616138 Enrollment ID: O20050222000479 |
Provider Name | Mcdonough County Hospital District |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1609180082 PECOS PAC ID: 0446140180 Enrollment ID: O20090407000082 |
Provider Name | Blessing Hospital |
---|---|
Provider Type | Part B Supplier - Hospital Department(s) |
Provider Identifiers | NPI Number: 1114471737 PECOS PAC ID: 3072422534 Enrollment ID: O20161005001836 |
Mailing Address | Practice Location Address |
---|---|
Idol Ray Mitchell, DPM 437 East Grant Street, Macomb, IL 61455-3352 Ph: (309) 837-3964 | Idol Ray Mitchell, DPM 437 East Grant Street, Macomb, IL 61455-3352 Ph: (309) 837-3964 |
Idol R Mitchell Dpm Pc Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 437 East Grant Street, Macomb, IL 61455 Phone: 309-837-3964 Fax: 309-837-3966 | |
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