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105 S Major St Eureka IL 61530-1246 | |
(309) 467-4691 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 105 S Major St, Eureka, Illinois |
Authorized Official Name and Position | Aron Klein (VICE PRESIDENT FINANCE) |
Authorized Official Contact | 3092682410 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1304 Franklin Ave Normal IL 61761-3558 Ph: (309) 268-2410 | 105 S Major St Eureka IL 61530-1246 Ph: (309) 467-4691 |
NPI Number | 1780101204 |
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Provider Enumeration Date | 08/25/2017 |
Last Update Date | 08/10/2020 |
Medicare PECOS PAC ID | 3870914393 |
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Medicare Enrollment ID | O20200611002200 |
Identifier | Type | State | Issuer |
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1780101204 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |