| Atwood Medical, Llc | |
|
1400 N East St Olney IL 62450-2426 | |
| (618) 395-1400 | |
| (618) 395-1405 |
| Full Name | Atwood Medical, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1400 N East St, Olney, Illinois |
| Authorized Official Name and Position | Brian L Atwood (PRESIDENT) |
| Authorized Official Contact | 6183951400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atwood Medical, Llc 1400 N East St Olney IL 62450-2426 Ph: (618) 395-1400 | Atwood Medical, Llc 1400 N East St Olney IL 62450-2426 Ph: (618) 395-1400 |
| NPI Number | 1760688642 |
|---|---|
| Provider Enumeration Date | 06/26/2007 |
| Last Update Date | 03/30/2023 |
| Medicare PECOS PAC ID | 5890778740 |
|---|---|
| Medicare Enrollment ID | O20040610001500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760688642 | NPI | - | NPPES |
| 332782580 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036-110096 (Illinois) | Primary |
| Provider Name | Brian L Atwood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235182809 PECOS PAC ID: 0143216937 Enrollment ID: I20040614000514 |
| Provider Name | Melissa N Kuenstler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134469364 PECOS PAC ID: 4486892510 Enrollment ID: I20130601000114 |
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