Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 205 S 3rd St, Girard, Illinois |
Authorized Official Name and Position | David Paul Courtney (CFO) |
Authorized Official Contact | 2178543141 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
205 S 3rd St Girard IL 62640-1547 Ph: (217) 627-2222 | 205 S 3rd St Girard IL 62640-1547 Ph: (217) 627-2222 |
NPI Number | 1447691571 |
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Provider Enumeration Date | 07/17/2013 |
Last Update Date | 01/30/2023 |
Medicare PECOS PAC ID | 9032021373 |
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Medicare Enrollment ID | O20131017000512 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447691571 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |