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203 E Grant St Coulterville IL 62237-1623 | |
(618) 758-2331 | |
(618) 758-2819 |
Full Name | |
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Speciality | Clinic/Center |
Location | 203 E Grant St, Coulterville, Illinois |
Authorized Official Name and Position | Lisa Ernsting (CFO) |
Authorized Official Contact | 6184432177 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 297 Sparta IL 62286-0297 Ph: (618) 443-1337 | 203 E Grant St Coulterville IL 62237-1623 Ph: (618) 758-2331 |
NPI Number | 1083721567 |
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Provider Enumeration Date | 08/23/2006 |
Last Update Date | 05/16/2023 |
Medicare PECOS PAC ID | 6709870462 |
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Medicare Enrollment ID | O20070709000284 |
Identifier | Type | State | Issuer |
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1083721567 | NPI | - | NPPES |
143465 | Other | IL | RHC PROVIDER LOCATION NUM |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |