| |
927 Broadway St Quincy IL 62301-2719 | |
(217) 223-8400 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 927 Broadway St, Quincy, Illinois |
Authorized Official Name and Position | Timothy A Moore (VP FINANCE, CAO) |
Authorized Official Contact | 2172238400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1005 Broadway St Quincy IL 62301-2834 Ph: (217) 223-8400 | 927 Broadway St Quincy IL 62301-2719 Ph: (217) 223-8400 |
NPI Number | 1700478203 |
---|---|
Provider Enumeration Date | 02/05/2021 |
Last Update Date | 07/11/2022 |
Medicare PECOS PAC ID | 3072422534 |
---|---|
Medicare Enrollment ID | O20210518001811 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700478203 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Blessing Walk-in Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3700 Broadway St, Quincy, IL 62305 Phone: 217-228-1060 | |
Board Of Trustees Of Southern Illinois University Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 205 S 24th St Ste 100, Quincy, IL 62301 Phone: 217-224-9484 Fax: 217-224-7950 |