| Irvington Friendly Care, Pc | |
|
205 Huron Irvington IL 62848 | |
| (618) 249-6203 | |
| (618) 249-6263 |
| Full Name | Irvington Friendly Care, Pc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 205 Huron, Irvington, Illinois |
| Authorized Official Name and Position | Jerry L Beguelin (PRESIDENT) |
| Authorized Official Contact | 6182496203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Irvington Friendly Care, Pc Po Box 190 Irvington IL 62848-0190 Ph: (618) 249-6203 | Irvington Friendly Care, Pc 205 Huron Irvington IL 62848 Ph: (618) 249-6203 |
| NPI Number | 1922145002 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922145002 | NPI | - | NPPES |
| 1245228881 | Other | IL | NPI |
| 36038738 | Other | IL | STATE LICENSE NUMBER |
| 333462458000 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 36038738 (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (Illinois) | Primary |
St. Mary's Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 Huron, Irvington, IL 62848 Phone: 618-249-6203 |