| Jefferson Street Clinic, Sc | |
|
107 E Jefferson Street Morton IL 61550-0180 | |
| (309) 266-9711 | |
| (309) 266-6322 |
| Full Name | Jefferson Street Clinic, Sc |
|---|---|
| Speciality | Clinic/center |
| Location | 107 E Jefferson Street, Morton, Illinois |
| Authorized Official Name and Position | Larry Stephen Patton (PRESIDENT) |
| Authorized Official Contact | 3092669711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Street Clinic, Sc 107 E Jefferson St Po Box 180 Morton IL 61550-2001 Ph: (309) 266-9711 | Jefferson Street Clinic, Sc 107 E Jefferson Street Morton IL 61550-0180 Ph: (309) 266-9711 |
| NPI Number | 1366637258 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 09/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366637258 | NPI | - | NPPES |
| 9015653 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Illinois) | Primary |
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