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407 S Chestnut St De Soto IL 62924-1400 | |
(618) 867-2703 | |
(618) 867-2353 |
Full Name | |
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Speciality | Family Medicine |
Location | 407 S Chestnut St, De Soto, Illinois |
Authorized Official Name and Position | Janet L Austin (OFFICE MANAGER) |
Authorized Official Contact | 6186872353 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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407 S Chestnut Po Box 104 Desoto IL 62924-1400 Ph: (618) 867-2703 | 407 S Chestnut St De Soto IL 62924-1400 Ph: (618) 867-2703 |
NPI Number | 1184829996 |
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Provider Enumeration Date | 06/20/2007 |
Last Update Date | 10/09/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184829996 | NPI | - | NPPES |
143890 | Other | IL | MEDICARE RURAL HEALTH |
039-00152 | Other | IL | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 036099723 (Illinois) | Primary |
261QR1300X | Clinic/center - Rural Health | 036066913 (Illinois) | Secondary |