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407 South Jackson Street Suite A Cerro Gordo IL 61818-4356 | |
(217) 763-6010 | |
(217) 763-6012 |
Full Name | |
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Speciality | Clinic/Center |
Location | 407 South Jackson Street, Cerro Gordo, Illinois |
Authorized Official Name and Position | Steven D Tenhouse (CEO) |
Authorized Official Contact | 2177621501 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1000 Medical Center Dr Monticello IL 61856-2116 Ph: (217) 762-1540 | 407 South Jackson Street Suite A Cerro Gordo IL 61818-4356 Ph: (217) 763-6010 |
NPI Number | 1508219288 |
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Provider Enumeration Date | 07/19/2016 |
Last Update Date | 12/11/2020 |
Medicare PECOS PAC ID | 6901791144 |
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Medicare Enrollment ID | O20171226001002 |
Identifier | Type | State | Issuer |
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1508219288 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |