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207 S Burns Ave Sparta IL 62286-1857 | |
(618) 443-3084 | |
(618) 443-1347 |
Full Name | |
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Speciality | Clinic/Center |
Location | 207 S Burns Ave, Sparta, Illinois |
Authorized Official Name and Position | Lisa Ernsting (CFO) |
Authorized Official Contact | 6184332177 |
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 297 Sparta IL 62286-0297 Ph: (618) 443-1337 | 207 S Burns Ave Sparta IL 62286-1857 Ph: (618) 443-3084 |
NPI Number | 1750497194 |
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Provider Enumeration Date | 08/21/2006 |
Last Update Date | 05/16/2023 |
Medicare PECOS PAC ID | 6709870462 |
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Medicare Enrollment ID | O20070710000009 |
Identifier | Type | State | Issuer |
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1750497194 | NPI | - | NPPES |
143466 | Other | IL | OSCAR NUMBER |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |