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211 S Burns Ave Sparta IL 62286-1895 | |
(618) 443-1303 | |
(618) 443-1474 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 211 S Burns Ave, Sparta, Illinois |
Authorized Official Name and Position | Lisa Ernsting (CFO) |
Authorized Official Contact | 6184332177 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 297 Sparta IL 62286-0297 Ph: (618) 443-1337 | 211 S Burns Ave Sparta IL 62286-1895 Ph: (618) 443-1303 |
NPI Number | 1922242130 |
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Provider Enumeration Date | 05/01/2009 |
Last Update Date | 03/25/2024 |
Identifier | Type | State | Issuer |
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1922242130 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |