| 15 Park Place Llc | |
|
15 Park Pl Ste 1 Swansea IL 62226-2918 | |
| (618) 580-1359 | |
| (618) 234-7242 |
| Full Name | 15 Park Place Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 15 Park Pl Ste 1, Swansea, Illinois |
| Authorized Official Name and Position | Clara Ampadu (CEO) |
| Authorized Official Contact | 6185801359 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 15 Park Place Llc 15 Park Pl Ste 1 Swansea IL 62226-2918 Ph: (618) 580-1359 | 15 Park Place Llc 15 Park Pl Ste 1 Swansea IL 62226-2918 Ph: (618) 580-1359 |
| NPI Number | 1447870274 |
|---|---|
| Provider Enumeration Date | 04/22/2020 |
| Last Update Date | 07/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447870274 | NPI | - | NPPES |
| 0360832704 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |
Deatrice L Kellogg Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2661 N Illinois St, Pmb 309, Swansea, IL 62226 Phone: 618-257-2029 Fax: 618-235-5371 | |
Figure 8 Integrative Health & Wellness Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15 Park Pl Ste C, Swansea, IL 62226 Phone: 732-425-4363 Fax: 618-257-0715 | |
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