Marissa Medical Clinic | |
521 N Borders Ave Ste C Marissa IL 62257-1195 | |
(618) 295-1591 | |
(618) 295-1473 |
Full Name | Marissa Medical Clinic |
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Speciality | Clinic/Center |
Location | 521 N Borders Ave Ste C, Marissa, Illinois |
Authorized Official Name and Position | Lisa Ernsting (CFO) |
Authorized Official Contact | 6184332177 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Marissa Medical Clinic Po Box 297 Sparta IL 62286-0297 Ph: (618) 443-1337 | Marissa Medical Clinic 521 N Borders Ave Ste C Marissa IL 62257-1195 Ph: (618) 295-1591 |
NPI Number | 1922114800 |
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Provider Enumeration Date | 08/22/2006 |
Last Update Date | 05/16/2023 |
Medicare PECOS PAC ID | 6709870462 |
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Medicare Enrollment ID | O20061011000057 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922114800 | NPI | - | NPPES |
143490 | Other | IL | RHC PROVIDER NUMBER OSCAR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |