Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 209 E 5th Street, Bowen, Illinois |
Authorized Official Name and Position | Ada M Bair (CEO) |
Authorized Official Contact | 2173578566 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 105 Bowen IL 62316-0105 Ph: (217) 842-5211 | 209 E 5th Street Bowen IL 62316 Ph: (217) 842-5211 |
NPI Number | 1437100831 |
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Provider Enumeration Date | 05/12/2006 |
Last Update Date | 04/05/2019 |
Medicare PECOS PAC ID | 0244134682 |
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Medicare Enrollment ID | O20051220000373 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437100831 | NPI | - | NPPES |
3420307 | Other | IL | BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 0001529 (Illinois) | Primary |