| Mdh Pediatric Clinic | |
|
505 E Grant St Ste 202 Macomb IL 61455-3373 | |
| (309) 833-1729 | |
| (309) 836-1779 |
| Full Name | Mdh Pediatric Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 505 E Grant St Ste 202, Macomb, Illinois |
| Authorized Official Name and Position | William Murdock (CFO) |
| Authorized Official Contact | 5632443511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mdh Pediatric Clinic Po Box 1179 Macomb IL 61455-5579 Ph: (309) 836-1524 | Mdh Pediatric Clinic 505 E Grant St Ste 202 Macomb IL 61455-3373 Ph: (309) 833-1729 |
| NPI Number | 1770100414 |
|---|---|
| Provider Enumeration Date | 06/29/2020 |
| Last Update Date | 06/29/2020 |
| Medicare PECOS PAC ID | 0446140180 |
|---|---|
| Medicare Enrollment ID | O20200715003325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770100414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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