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3106 Outer Dr Marion IL 62959-5270 | |
(618) 997-4332 | |
(618) 997-6205 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3106 Outer Dr, Marion, Illinois |
Authorized Official Name and Position | Warren P Ladner (SENIOR VP CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 6184575200 |
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 3988 Carbondale IL 62902-3988 Ph: (618) 457-5200 | 3106 Outer Dr Marion IL 62959-5270 Ph: (618) 997-4332 |
NPI Number | 1649795659 |
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Provider Enumeration Date | 08/10/2017 |
Last Update Date | 01/07/2025 |
Medicare PECOS PAC ID | 9638083884 |
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Medicare Enrollment ID | O20171024000135 |
Identifier | Type | State | Issuer |
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1649795659 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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