| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 815 E 5th St, Alton, Illinois |
| Authorized Official Name and Position | Larry Mcculley (PRESIDENT) |
| Authorized Official Contact | 6183320694 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8080 State St East Saint Louis IL 62203-1808 Ph: (618) 397-3303 | 815 E 5th St Alton IL 62002-6471 Ph: (618) 397-3303 |
| NPI Number | 1346402062 |
|---|---|
| Provider Enumeration Date | 06/25/2008 |
| Last Update Date | 07/22/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346402062 | NPI | - | NPPES |
| 732740 | Other | IL | WPS MEDICARE PART B |
| 14-1089 | Other | IL | NGS MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Cep America - Illinois Hospitalists, Llp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1 Saint Anthonys Way, Alton, IL 62002 Phone: 618-465-2571 | |
Cep America - Illinois Snf, Llp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3523 Wickenhauser Ave, Alton, IL 62002 Phone: 618-465-8887 | |
E J Aragona Md Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 108 Northport Dr, Alton, IL 62002 Phone: 618-466-6177 Fax: 618-466-6388 | |
Cep America - Illinois Snf, Llp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3490 Humbert Rd, Alton, IL 62002 Phone: 618-465-2626 |