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2 Myrtle Lane Hardin IL 62047-0310 | |
(618) 576-2416 | |
(618) 576-9298 |
Full Name | |
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Speciality | Family Medicine |
Location | 2 Myrtle Lane, Hardin, Illinois |
Authorized Official Name and Position | Janeth Concepcion Jacinto-zata (PHYSICIAN PCP) |
Authorized Official Contact | 6185762416 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2 Myrtle Lane P.o Box 310 Hardin IL 62047-0310 Ph: (618) 576-2416 | 2 Myrtle Lane Hardin IL 62047-0310 Ph: (618) 576-2416 |
NPI Number | 1306933262 |
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Provider Enumeration Date | 10/10/2006 |
Last Update Date | 10/09/2008 |
Identifier | Type | State | Issuer |
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1306933262 | NPI | - | NPPES |
0000715000 | Other | IL | BCBS |
036051832 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 036-051832 (Illinois) | Primary |