| Forrest Family Practice Llc | |
|
122 E Wabash Ave Forrest IL 61741 | |
| (815) 657-8707 | |
| (815) 657-8717 |
| Full Name | Forrest Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 122 E Wabash Ave, Forrest, Illinois |
| Authorized Official Name and Position | Benjamin E Brewer (OWNER) |
| Authorized Official Contact | 8156578707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Forrest Family Practice Llc 122 E Wabash Ave P O Box 58 Forrest IL 61741 Ph: (815) 657-8707 | Forrest Family Practice Llc 122 E Wabash Ave Forrest IL 61741 Ph: (815) 657-8707 |
| NPI Number | 1104003086 |
|---|---|
| Provider Enumeration Date | 01/23/2008 |
| Last Update Date | 07/02/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104003086 | NPI | - | NPPES |
| 364468162001 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Prairie Family Medicine And Obstetrics Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 122 E Wabash Ave, Forrest, IL 61741 Phone: 815-657-8707 Fax: 815-657-8717 |