| |
1325 W Whittaker St Suite 3 Salem IL 62881-2007 | |
(618) 548-4911 | |
(618) 548-8052 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1325 W Whittaker St, Salem, Illinois |
Authorized Official Name and Position | Debbie T Brewer (DIRECTOR OF PROVIDER ENROLLMENT) |
Authorized Official Contact | 6154657626 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1325 W Whittaker St Suite 3 Salem IL 62881-2007 Ph: (618) 548-4911 | 1325 W Whittaker St Suite 3 Salem IL 62881-2007 Ph: (618) 548-4911 |
NPI Number | 1598759516 |
---|---|
Provider Enumeration Date | 09/06/2005 |
Last Update Date | 09/18/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598759516 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (Illinois) | Primary |
363L00000X | Nurse Practitioner | (Illinois) | Secondary |
Anton Dubrick Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 420 W Schwartz St, Salem, IL 62881 Phone: 618-740-4667 Fax: 618-740-1482 | |