| |
180 S Main St Canton IL 61520-2608 | |
(309) 647-0201 | |
(309) 649-5302 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 180 S Main St, Canton, Illinois |
Authorized Official Name and Position | Julie Reeder (VP OF FINANCE/CFO) |
Authorized Official Contact | 3096475240 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
180 S Main St Canton IL 61520-2608 Ph: (309) 647-0201 | 180 S Main St Canton IL 61520-2608 Ph: (309) 647-0201 |
NPI Number | 1205072626 |
---|---|
Provider Enumeration Date | 01/07/2009 |
Last Update Date | 10/23/2018 |
Medicare PECOS PAC ID | 2769375021 |
---|---|
Medicare Enrollment ID | O20080811000262 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205072626 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | 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 | |