| Elbert A Fasnacht Ii Md Ltd | |
|
721 South Lewis Lane Carbondale IL 62901-3344 | |
| (618) 457-4999 | |
| (618) 457-5099 |
| Full Name | Elbert A Fasnacht Ii Md Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 721 South Lewis Lane, Carbondale, Illinois |
| Authorized Official Name and Position | Elbert Alvin Fasnacht (PRESIDENT) |
| Authorized Official Contact | 6184574999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elbert A Fasnacht Ii Md Ltd 721 South Lewis Lane Carbondale IL 62901-3344 Ph: (618) 457-4999 | Elbert A Fasnacht Ii Md Ltd 721 South Lewis Lane Carbondale IL 62901-3344 Ph: (618) 457-4999 |
| NPI Number | 1962582700 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 09/10/2009 |
| Medicare PECOS PAC ID | 7810050424 |
|---|---|
| Medicare Enrollment ID | O20090108000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962582700 | NPI | - | NPPES |
| 036075250 | Medicaid | IL | |
| DP1138 | Other | IL | RAILROAD MEDICARE |
| 027366 | Other | IL | HEALTH ALLIANCE |
| 137121 | Other | IL | HEALTHLINK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036075250 (Illinois) | Primary |
| Provider Name | Elbert A Fasnacht |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790834828 PECOS PAC ID: 8628079357 Enrollment ID: I20070124000310 |
Student Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 374 East Grand Avenue, Mail Code 674d, Carbondale, IL 62901 Phone: 618-453-3311 Fax: 618-453-4449 | |
The Carbondale Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2601 W Main St, Carbondale, IL 62901 Phone: 618-457-5200 Fax: 618-549-5128 | |
Cedar Court Specialty Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1250 Cedar Ct, Carbondale, IL 62901 Phone: 618-351-1213 Fax: 618-351-1905 | |
Southern Illinois Gi Specialists Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1100 W Diann Ln, Carbondale, IL 62901 Phone: 618-549-8006 Fax: 618-549-8434 | |
Carbondale Community High Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 330 S Giant City Rd, Carbondale, IL 62902 Phone: 618-457-4722 Fax: 618-457-3353 | |
Center For Medical Arts Rural Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2601 W Main St, Carbondale, IL 62901 Phone: 618-549-5361 Fax: 618-351-4878 | |
Board Of Trustees Of Southern Illinois University Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 W Oak St Ste 100, Carbondale, IL 62901 Phone: 217-545-8000 |