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1102 N County Road 700 Warsaw IL 62379-3011 | |
(217) 256-4100 | |
(217) 256-3800 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1102 N County Road 700, Warsaw, Illinois |
Authorized Official Name and Position | Tim Moore (VP FINANCE / CAO) |
Authorized Official Contact | 2172231200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1102 N County Road 700 Warsaw IL 62379-3011 Ph: (217) 256-4100 | 1102 N County Road 700 Warsaw IL 62379-3011 Ph: (217) 256-4100 |
NPI Number | 1720186265 |
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Provider Enumeration Date | 09/20/2006 |
Last Update Date | 02/04/2021 |
Medicare PECOS PAC ID | 5991616138 |
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Medicare Enrollment ID | O20030910000038 |
Identifier | Type | State | Issuer |
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1720186265 | NPI | - | NPPES |
6237901 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |