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311 Hurst Rd De Soto IL 62924-1228 | |
(618) 867-2317 | |
(618) 867-3233 |
Full Name | |
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Speciality | Clinic/center - Student Health |
Location | 311 Hurst Rd, De Soto, Illinois |
Authorized Official Name and Position | Mark Edward Bullock (SUPERINTENDENT) |
Authorized Official Contact | 6188672317 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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311 Hurst Rd De Soto IL 62924-1228 Ph: (618) 867-2317 | 311 Hurst Rd De Soto IL 62924-1228 Ph: (618) 867-2317 |
NPI Number | 1225200850 |
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Provider Enumeration Date | 03/24/2008 |
Last Update Date | 04/20/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225200850 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QS1000X | Clinic/center - Student Health | (Illinois) | Primary |