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122 E Elm St Mason City IL 62664-1410 | |
(309) 543-8564 | |
(309) 543-2089 |
Full Name | |
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Speciality | Clinic/Center |
Location | 122 E Elm St, Mason City, Illinois |
Authorized Official Name and Position | Robert J Stolba (CFO) |
Authorized Official Contact | 3095438505 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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615 N Promenade St P O Box 530 Havana IL 62644-1015 Ph: (309) 543-8564 | 122 E Elm St Mason City IL 62664-1410 Ph: (309) 543-8564 |
NPI Number | 1932166931 |
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Provider Enumeration Date | 04/26/2006 |
Last Update Date | 12/10/2010 |
Medicare PECOS PAC ID | 2466360607 |
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Medicare Enrollment ID | O20100506000867 |
Identifier | Type | State | Issuer |
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1932166931 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (Illinois) | Primary |