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209 E Grand Prairie St Palestine IL 62451-1254 | |
(618) 544-8600 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 209 E Grand Prairie St, Palestine, Illinois |
Authorized Official Name and Position | Debbie Kiehl (PRACTICE MANAGEMENT OFFICER) |
Authorized Official Contact | 6185448600 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1101 N Allen St Robinson IL 62454-1168 Ph: (618) 544-8600 | 209 E Grand Prairie St Palestine IL 62451-1254 Ph: (618) 544-8600 |
NPI Number | 1538105523 |
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Provider Enumeration Date | 06/20/2006 |
Last Update Date | 03/15/2011 |
Medicare PECOS PAC ID | 7719898071 |
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Medicare Enrollment ID | O20060911000350 |
Identifier | Type | State | Issuer |
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1538105523 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |