Full Name | |
---|---|
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 |
---|---|
122 E Wabash Ave P O Box 58 Forrest IL 61741 Ph: (815) 657-8707 | 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 |