| |
1490 E Walnut St Suite C Watseka IL 60970-1806 | |
(815) 432-8200 | |
(815) 432-8201 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1490 E Walnut St, Watseka, Illinois |
Authorized Official Name and Position | Harry Brockus (CEO) |
Authorized Official Contact | 2172838540 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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611 W. Park St. Bwpc Urbana IL 61801-2500 Ph: (217) 383-6792 | 1490 E Walnut St Suite C Watseka IL 60970-1806 Ph: (815) 432-8200 |
NPI Number | 1467549402 |
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Provider Enumeration Date | 10/10/2006 |
Last Update Date | 05/12/2016 |
Medicare PECOS PAC ID | 3577456037 |
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Medicare Enrollment ID | O20120814000494 |
Identifier | Type | State | Issuer |
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1467549402 | NPI | - | NPPES |
210046 | Other | IL | WPS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 0004200 (Illinois) | Primary |
Gonzalo T Florido Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 714 S 10th St, Watseka, IL 60970 Phone: 815-432-6744 | |