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1404 N 5th St Vandalia IL 62471-1039 | |
(618) 283-2000 | |
(618) 283-2002 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1404 N 5th St, Vandalia, Illinois |
Authorized Official Name and Position | Penny Attaway (DNP) |
Authorized Official Contact | 6189711440 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1404 N 5th St Vandalia IL 62471-1039 Ph: (618) 283-2000 | 1404 N 5th St Vandalia IL 62471-1039 Ph: (618) 283-2000 |
NPI Number | 1528185170 |
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Provider Enumeration Date | 03/26/2007 |
Last Update Date | 12/20/2016 |
Medicare PECOS PAC ID | 9931016961 |
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Medicare Enrollment ID | O20160203000586 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528185170 | NPI | - | NPPES |
L040233 | Other | IL | TRICARE |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 209001693 (Illinois) | Primary |
Brian W Dossett Md Ltd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1029 N 8th St, Vandalia, IL 62471 Phone: 618-283-4469 Fax: 618-283-4794 | |
Kaskaskia Medical Center, Ltd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1003 N 8th St, Vandalia, IL 62471 Phone: 618-283-4445 Fax: 618-283-4446 | |