| Adult Internal Medicine Practice Llc | |
|
15 Park Pl Swansea IL 62226-2918 | |
| (618) 257-0780 | |
| (618) 257-0715 |
| Full Name | Adult Internal Medicine Practice Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 15 Park Pl, Swansea, Illinois |
| Authorized Official Name and Position | Charles W Ampadu (OWNER) |
| Authorized Official Contact | 6182570780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adult Internal Medicine Practice Llc 15 Park Pl Swansea IL 62226-2918 Ph: (618) 257-0780 | Adult Internal Medicine Practice Llc 15 Park Pl Swansea IL 62226-2918 Ph: (618) 257-0780 |
| NPI Number | 1265688238 |
|---|---|
| Provider Enumeration Date | 08/11/2008 |
| Last Update Date | 09/06/2021 |
| Medicare PECOS PAC ID | 9638244494 |
|---|---|
| Medicare Enrollment ID | O20080814000050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265688238 | NPI | - | NPPES |
| 036083270 | Medicaid | IL | |
| 08227444 | Other | IL | BCBS |
| 32871 | Other | GHP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Charles Ampadu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962545269 PECOS PAC ID: 3971693474 Enrollment ID: I20071220000588 |
| Provider Name | Clara Ampadu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578096806 PECOS PAC ID: 9234304296 Enrollment ID: I20170524002577 |
| Provider Name | Charity Wambui Nyuguto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013663160 PECOS PAC ID: 5092198259 Enrollment ID: I20220821000011 |
| Provider Name | Sara Seider |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598449910 PECOS PAC ID: 5092169110 Enrollment ID: I20230922003457 |
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