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2071 Goose Lake Rd Sauget IL 62206-2822 | |
(618) 332-5369 | |
(618) 337-9482 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 2071 Goose Lake Rd, Sauget, Illinois |
Authorized Official Name and Position | Larry Mcculley (CHIEF OPERATING OFFICER) |
Authorized Official Contact | 6183320783 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8080 State St East Saint Louis IL 62203-1808 Ph: (618) 397-3303 | 2071 Goose Lake Rd Sauget IL 62206-2822 Ph: (618) 332-5369 |
NPI Number | 1467482968 |
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Provider Enumeration Date | 07/03/2006 |
Last Update Date | 10/30/2008 |
Identifier | Type | State | Issuer |
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1467482968 | NPI | - | NPPES |
732740 | Other | IL | WPS MEDICARE GROUP NUMBER |