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700 East Oak Street Canton IL 61520 | |
(309) 647-1134 | |
(309) 647-9545 |
Full Name | |
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Speciality | Clinic/center - Public Health, State Or Local |
Location | 700 East Oak Street, Canton, Illinois |
Authorized Official Name and Position | Damon Scott Roberson (ADMINISTRATOR) |
Authorized Official Contact | 3096471134 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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700 East Oak Street Canton IL 61520 Ph: (309) 647-1134 | 700 East Oak Street Canton IL 61520 Ph: (309) 647-1134 |
NPI Number | 1245216241 |
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Provider Enumeration Date | 12/21/2005 |
Last Update Date | 04/22/2015 |
Identifier | Type | State | Issuer |
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1245216241 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Secondary |
261QP0905X | Clinic/center - Public Health, State Or Local | (Illinois) | Primary |
Spoon River Family Practice Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 45 E Side Sq, Suite 102, Canton, IL 61520 Phone: 309-647-9980 Fax: 309-647-7792 | |