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818 E Broadway St Sparta IL 62286-1820 | |
(618) 939-4200 | |
(618) 939-4256 |
Full Name | |
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Speciality | Family Medicine |
Location | 818 E Broadway St, Sparta, Illinois |
Authorized Official Name and Position | Kyle Dillman (SECRETARY / TREASURER) |
Authorized Official Contact | 8124507399 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 34156 Belfast ME 04915-0619 Ph: (812) 450-6815 | 818 E Broadway St Sparta IL 62286-1820 Ph: (618) 939-4200 |
NPI Number | 1992422539 |
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Provider Enumeration Date | 10/25/2022 |
Last Update Date | 12/02/2022 |
Identifier | Type | State | Issuer |
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1992422539 | NPI | - | NPPES |