| Columbian Boulevard Dental Clinic | |
|
125 W Columbian Blvd S Litchfield IL 62056-3021 | |
| (217) 854-3223 | |
| Not Available |
| Full Name | Columbian Boulevard Dental Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 125 W Columbian Blvd S, Litchfield, Illinois |
| Authorized Official Name and Position | Christy Blank (CEO) |
| Authorized Official Contact | 2179302283 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbian Boulevard Dental Clinic 805 N Broad St Carlinville IL 62626-1075 Ph: (217) 839-4141 | Columbian Boulevard Dental Clinic 125 W Columbian Blvd S Litchfield IL 62056-3021 Ph: (217) 854-3223 |
| NPI Number | 1831798958 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 04/13/2023 |
| Medicare PECOS PAC ID | 1557377850 |
|---|---|
| Medicare Enrollment ID | O20201229001853 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831798958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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