| John R Deforest D.o. S.c. | |
|
715 S Dixie Hwy Beecher IL 60401-3668 | |
| (708) 946-9330 | |
| (708) 946-2471 |
| Full Name | John R Deforest D.o. S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 715 S Dixie Hwy, Beecher, Illinois |
| Authorized Official Name and Position | Karen Ruckman (ACCT REP.) |
| Authorized Official Contact | 7089463990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John R Deforest D.o. S.c. 715 S Dixie Hwy Beecher IL 60401-3668 Ph: (708) 946-9330 | John R Deforest D.o. S.c. 715 S Dixie Hwy Beecher IL 60401-3668 Ph: (708) 946-9330 |
| NPI Number | 1144241407 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 12/10/2014 |
| Medicare PECOS PAC ID | 2769495431 |
|---|---|
| Medicare Enrollment ID | O20060725000088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144241407 | NPI | - | NPPES |
| 0360899981 | Medicaid | IL | |
| 080154175 | Other | IL | RAILROAD MEDICARE |
| 9925692 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 336051704 (Illinois) | Primary |
| Provider Name | John R Deforest |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003842964 PECOS PAC ID: 9931112604 Enrollment ID: I20060725000107 |
| Provider Name | Sandra Hillegonds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245635085 PECOS PAC ID: 0648587105 Enrollment ID: I20150916000004 |
Virtuele Med Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 987 Dixie Hwy, Beecher, IL 60401 Phone: 630-818-7186 |