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221 Wal Crest Dr Fairbury IL 61739-8998 | |
(815) 692-1150 | |
(815) 692-1153 |
Full Name | |
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Speciality | Family Medicine |
Location | 221 Wal Crest Dr, Fairbury, Illinois |
Authorized Official Name and Position | Matthew Ertel (CFO) |
Authorized Official Contact | 2177842600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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221 Wal Crest Dr Fairbury IL 61739-8998 Ph: (815) 692-1150 | 221 Wal Crest Dr Fairbury IL 61739-8998 Ph: (815) 692-1150 |
NPI Number | 1548544679 |
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Provider Enumeration Date | 10/07/2011 |
Last Update Date | 11/08/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548544679 | NPI | - | NPPES |
825130 | Other | IL | MEDICARE PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 0000836 (Illinois) | Primary |