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508 E Crescent St Gilman IL 60938-1702 | |
(812) 265-8889 | |
(815) 265-8332 |
Full Name | |
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Speciality | Clinic/Center |
Location | 508 E Crescent St, Gilman, Illinois |
Authorized Official Name and Position | Timothy Smith (COO) |
Authorized Official Contact | 8154327967 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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508 E Crescent St Gilman IL 60938-1702 Ph: (812) 265-8889 | 508 E Crescent St Gilman IL 60938-1702 Ph: (812) 265-8889 |
NPI Number | 1366469132 |
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Provider Enumeration Date | 07/16/2006 |
Last Update Date | 01/17/2017 |
Medicare PECOS PAC ID | 4385551258 |
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Medicare Enrollment ID | O20100603000659 |
Identifier | Type | State | Issuer |
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1366469132 | NPI | - | NPPES |
0003815088 | Other | IL | BCBS OF IL |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |