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414 S State St Roodhouse IL 62082-1544 | |
(217) 589-4383 | |
(217) 589-4409 |
Full Name | |
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Speciality | Clinic/Center |
Location | 414 S State St, Roodhouse, Illinois |
Authorized Official Name and Position | Beth A King (CFO) |
Authorized Official Contact | 6184988350 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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390 Maple Summit Rd Jerseyville IL 62052-2000 Ph: (618) 498-7518 | 414 S State St Roodhouse IL 62082-1544 Ph: (217) 589-4383 |
NPI Number | 1770988735 |
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Provider Enumeration Date | 11/03/2014 |
Last Update Date | 03/31/2020 |
Medicare PECOS PAC ID | 4587650445 |
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Medicare Enrollment ID | O20141210001995 |
Identifier | Type | State | Issuer |
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1770988735 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 0001156 (Illinois) | Primary |