| |
1370 Mulholland St Nauvoo IL 62354-1010 | |
(217) 453-6802 | |
(217) 453-2149 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1370 Mulholland St, Nauvoo, Illinois |
Authorized Official Name and Position | Teresa Smith (CFO) |
Authorized Official Contact | 2173578573 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 160 Carthage IL 62321-0160 Ph: (217) 357-6594 | 1370 Mulholland St Nauvoo IL 62354-1010 Ph: (217) 453-6802 |
NPI Number | 1891972451 |
---|---|
Provider Enumeration Date | 01/25/2008 |
Last Update Date | 04/05/2019 |
Medicare PECOS PAC ID | 0244134682 |
---|---|
Medicare Enrollment ID | O20140414000003 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891972451 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |