| |
203 Bailey Ln Suite 1 Benton IL 62812-1969 | |
(618) 438-5670 | |
(618) 438-5709 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 203 Bailey Ln, Benton, Illinois |
Authorized Official Name and Position | Warren P Ladner (SENIOR VP CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 6184575200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 3988 Carbondale IL 62902-3988 Ph: (618) 457-5200 | 203 Bailey Ln Suite 1 Benton IL 62812-1969 Ph: (618) 438-5670 |
NPI Number | 1780985135 |
---|---|
Provider Enumeration Date | 11/16/2010 |
Last Update Date | 01/07/2025 |
Medicare PECOS PAC ID | 3678677390 |
---|---|
Medicare Enrollment ID | O20110214000589 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780985135 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Christopher Greater Area Rural Health Planning Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 206 E Church St, Benton, IL 62812 Phone: 618-435-9888 Fax: 618-435-9889 | |
Christopher Greater Area Rural Health Planning Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 107 E Smith St Ste B, Benton, IL 62812 Phone: 618-435-9315 Fax: 618-435-9316 | |