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1204 Highway 164 East Oquawka IL 61469-0118 | |
(309) 867-2202 | |
(309) 867-3205 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1204 Highway 164 East, Oquawka, Illinois |
Authorized Official Name and Position | Shannon Courson (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3098672202 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 198 Oquawka IL 61469-0198 Ph: (309) 867-2202 | 1204 Highway 164 East Oquawka IL 61469-0118 Ph: (309) 867-2202 |
NPI Number | 1548314834 |
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Provider Enumeration Date | 01/23/2007 |
Last Update Date | 07/21/2023 |
Medicare PECOS PAC ID | 3577596030 |
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Medicare Enrollment ID | O20050914001384 |
Identifier | Type | State | Issuer |
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1548314834 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Illinois) | Primary |
Provider Name | Justine Link |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1356980031 PECOS PAC ID: 6305272352 Enrollment ID: I20241105000901 |