| |
2568 N 41st St East Saint Louis IL 62201-2204 | |
(618) 482-4015 | |
(618) 482-4806 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 2568 N 41st St, East Saint Louis, Illinois |
Authorized Official Name and Position | Larry Mcculley (PRESIDENT) |
Authorized Official Contact | 6183320783 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
8080 State St East Saint Louis IL 62203-1808 Ph: (618) 397-3303 | 2568 N 41st St East Saint Louis IL 62201-2204 Ph: (618) 482-4015 |
NPI Number | 1770648917 |
---|---|
Provider Enumeration Date | 12/27/2006 |
Last Update Date | 07/29/2009 |
Medicare PECOS PAC ID | 1456256874 |
---|---|
Medicare Enrollment ID | O20081030000237 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770648917 | NPI | - | NPPES |
Osh-il Physicians Group Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2420 State St, East Saint Louis, IL 62205 Phone: 618-318-8809 Fax: 618-615-4205 | |
Southern Illinois Regional Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1736 Kingshighway, East Saint Louis, IL 62204 Phone: 618-874-3120 Fax: 618-215-4048 | |
Kenneth Hall Regional Hospital, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 129 N 8th St, East Saint Louis, IL 62201 Phone: 618-482-7044 Fax: 618-482-7018 |