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200 E Walnut St Watseka IL 60970-1356 | |
(708) 747-7100 | |
(708) 747-0710 |
Full Name | |
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Speciality | Clinic/Center |
Location | 200 E Walnut St, Watseka, Illinois |
Authorized Official Name and Position | Christopher J Nordloh (CFO) |
Authorized Official Contact | 7087477100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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19990 Governors Hwy Olympia Fields IL 60461-1021 Ph: (708) 747-7100 | 200 E Walnut St Watseka IL 60970-1356 Ph: (708) 747-7100 |
NPI Number | 1649417759 |
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Provider Enumeration Date | 01/12/2009 |
Last Update Date | 03/22/2011 |
Medicare PECOS PAC ID | 7214846922 |
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Medicare Enrollment ID | O20100607000566 |
Identifier | Type | State | Issuer |
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1649417759 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Gonzalo T Florido Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 714 S 10th St, Watseka, IL 60970 Phone: 815-432-6744 | |