| Mid-central Ill Gast Ltd | |
|
2200 Jacobssen Dr Suite B Normal IL 61761-5516 | |
| (309) 451-1123 | |
| (309) 451-1212 |
| Full Name | Mid-central Ill Gast Ltd |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 2200 Jacobssen Dr, Normal, Illinois |
| Authorized Official Name and Position | Stephen S Matter (PRESIDENT) |
| Authorized Official Contact | 3094511123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-central Ill Gast Ltd 2200 Jacobssen Dr Suite B Normal IL 61761-5516 Ph: (309) 451-1123 | Mid-central Ill Gast Ltd 2200 Jacobssen Dr Suite B Normal IL 61761-5516 Ph: (309) 451-1123 |
| NPI Number | 1992845358 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 08/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992845358 | NPI | - | NPPES |
| 0360818161 | Medicaid | IL | |
| 05725403 | Other | IL | BLUECROSS BLUESHIELD |
| 0360788251 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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