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1442 N 8th St Suite C Vandalia IL 62471-1027 | |
(618) 283-0266 | |
(618) 283-4081 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1442 N 8th St, Vandalia, 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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1442 N 8th St Vandalia IL 62471-1031 Ph: (618) 283-0266 | 1442 N 8th St Suite C Vandalia IL 62471-1027 Ph: (618) 283-0266 |
NPI Number | 1568500510 |
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Provider Enumeration Date | 02/02/2007 |
Last Update Date | 09/26/2022 |
Medicare PECOS PAC ID | 5092614867 |
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Medicare Enrollment ID | O20221006000755 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568500510 | NPI | - | NPPES |
371363933002 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 042007886 (Illinois) | Primary |
Brian W Dossett Md Ltd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1029 N 8th St, Vandalia, IL 62471 Phone: 618-283-4469 Fax: 618-283-4794 | |
Kaskaskia Medical Center, Ltd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1003 N 8th St, Vandalia, IL 62471 Phone: 618-283-4445 Fax: 618-283-4446 | |