| Family Practice Medical Center Ltd | |
|
511 W Fairchild St Danville IL 61832-3801 | |
| (217) 431-2025 | |
| (217) 431-0014 |
| Full Name | Family Practice Medical Center Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 511 W Fairchild St, Danville, Illinois |
| Authorized Official Name and Position | George R Gindi (OWNER) |
| Authorized Official Contact | 2174312025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice Medical Center Ltd 511 W Fairchild St Danville IL 61832-3801 Ph: (217) 431-2025 | Family Practice Medical Center Ltd 511 W Fairchild St Danville IL 61832-3801 Ph: (217) 431-2025 |
| NPI Number | 1659312072 |
|---|---|
| Provider Enumeration Date | 06/09/2006 |
| Last Update Date | 04/25/2013 |
| Medicare PECOS PAC ID | 6103723184 |
|---|---|
| Medicare Enrollment ID | O20031217000722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659312072 | NPI | - | NPPES |
| 015566 | Other | IL | HEALTH ALLIANCE |
| 036100736 | Medicaid | IL | |
| 036087566 | Medicaid | IL | |
| 09232019 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 036087566 (Illinois) | Primary |
| 261QR1300X | Clinic/center - Rural Health | 036100736 (Illinois) | Secondary |
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