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101 South Division Stronghurst IL 61480 | |
(309) 924-1381 | |
(309) 924-1389 |
Full Name | |
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Speciality | Clinic/Center |
Location | 101 South Division, Stronghurst, Illinois |
Authorized Official Name and Position | Shannon Courson (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3098672202 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 240 Stronghurst IL 61480-0240 Ph: (309) 924-1381 | 101 South Division Stronghurst IL 61480 Ph: (309) 924-1381 |
NPI Number | 1972662658 |
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Provider Enumeration Date | 12/08/2006 |
Last Update Date | 07/21/2023 |
Medicare PECOS PAC ID | 3577596030 |
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Medicare Enrollment ID | O20070216000671 |
Identifier | Type | State | Issuer |
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1972662658 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Justine Link |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1356980031 PECOS PAC ID: 6305272352 Enrollment ID: I20241105000901 |