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515 N Main St Saint Elmo IL 62458-1638 | |
(618) 829-9200 | |
(618) 829-9309 |
Full Name | |
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Speciality | Clinic/Center |
Location | 515 N Main St, Saint Elmo, Illinois |
Authorized Official Name and Position | Sheri Hopkins (CHIEF COMPLIANCE OFFICER) |
Authorized Official Contact | 6182835444 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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515 N Main St Saint Elmo IL 62458-1638 Ph: (618) 829-9200 | 515 N Main St Saint Elmo IL 62458-1638 Ph: (618) 829-9200 |
NPI Number | 1811199532 |
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Provider Enumeration Date | 06/04/2007 |
Last Update Date | 09/26/2022 |
Medicare PECOS PAC ID | 5092614867 |
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Medicare Enrollment ID | O20230306001732 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811199532 | NPI | - | NPPES |
371363933001 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 042007886 (Illinois) | Primary |