| Desoto Family Medicine | |
|
407 S Chestnut St De Soto IL 62924-1400 | |
| (618) 867-2703 | |
| (618) 867-2353 |
| Full Name | Desoto Family Medicine |
|---|---|
| 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 |
|---|---|
| Desoto Family Medicine 407 S Chestnut Po Box 104 Desoto IL 62924-1400 Ph: (618) 867-2703 | Desoto Family Medicine 407 S Chestnut St De Soto IL 62924-1400 Ph: (618) 867-2703 |
| NPI Number | 1184829996 |
|---|---|
| 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 |
Desoto Cons School Districxt 86 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 311 Hurst Rd, De Soto, IL 62924 Phone: 618-867-2317 Fax: 618-867-3233 | |
Desoto Ccsd 86 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 311 Hurst Rd, De Soto, IL 62924 Phone: 618-867-2317 Fax: 618-867-3233 |