| Family Medical Clinic Pllc | |
|
1480 N Green Mount Rd Suite 200 O Fallon IL 62269-3466 | |
| (618) 622-3450 | |
| (618) 622-3468 |
| Full Name | Family Medical Clinic Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1480 N Green Mount Rd Suite 200, O Fallon, Illinois |
| Authorized Official Name and Position | Jacqueline Mudd (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2173241100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medical Clinic Pllc Po Box 483 Litchfield IL 62056-0483 Ph: (217) 324-1100 | Family Medical Clinic Pllc 1480 N Green Mount Rd Suite 200 O Fallon IL 62269-3466 Ph: (618) 622-3450 |
| NPI Number | 1477019909 |
|---|---|
| Provider Enumeration Date | 02/20/2019 |
| Last Update Date | 07/02/2020 |
| Medicare PECOS PAC ID | 1658614938 |
|---|---|
| Medicare Enrollment ID | O20190530001792 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477019909 | NPI | - | NPPES |
| DZ1647 | Other | IL | RAILROAD MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Amardeep Shrestha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730490525 PECOS PAC ID: 2668611575 Enrollment ID: I20130625000208 |
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