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50 Northgate Industrial Dr Granite City IL 62040-6805 | |
(618) 512-1919 | |
(618) 512-1920 |
Full Name | |
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Speciality | Clinic/Center |
Location | 50 Northgate Industrial Dr, Granite City, Illinois |
Authorized Official Name and Position | Megan Marie Taylor (MANGED CARE SUPERVISOR) |
Authorized Official Contact | 8889243786 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1003 Martin Luther King Dr Bloomington IL 61701-1429 Ph: () - | 50 Northgate Industrial Dr Granite City IL 62040-6805 Ph: (618) 512-1919 |
NPI Number | 1326417080 |
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Provider Enumeration Date | 09/23/2015 |
Last Update Date | 03/16/2023 |
Medicare PECOS PAC ID | 1052393063 |
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Medicare Enrollment ID | O20160919001079 |
Identifier | Type | State | Issuer |
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1326417080 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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