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712 College St Greenfield IL 62044-1409 | |
(217) 368-3051 | |
(217) 368-2213 |
Full Name | |
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Speciality | Clinic/Center |
Location | 712 College St, Greenfield, Illinois |
Authorized Official Name and Position | Stace Holland (CEO) |
Authorized Official Contact | 2179426946 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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712 College St Greenfield IL 62044-1409 Ph: (217) 368-3051 | 712 College St Greenfield IL 62044-1409 Ph: (217) 368-3051 |
NPI Number | 1912090960 |
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Provider Enumeration Date | 10/02/2006 |
Last Update Date | 04/22/2024 |
Medicare PECOS PAC ID | 8123085560 |
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Medicare Enrollment ID | O20080114000062 |
Identifier | Type | State | Issuer |
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1912090960 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |