| Millstadt Medical Clinic | |
|
60 Regency Pl Millstadt IL 62260-2210 | |
| (618) 476-9177 | |
| (618) 476-1890 |
| Full Name | Millstadt Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 60 Regency Pl, Millstadt, Illinois |
| Authorized Official Name and Position | Larry Mcculley (CEO) |
| Authorized Official Contact | 6183320694 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Millstadt Medical Clinic 2041 Goose Lake Rd Sauget IL 62206-2822 Ph: (618) 332-0953 | Millstadt Medical Clinic 60 Regency Pl Millstadt IL 62260-2210 Ph: (618) 476-9177 |
| NPI Number | 1811236458 |
|---|---|
| Provider Enumeration Date | 02/01/2013 |
| Last Update Date | 02/01/2013 |
| Medicare PECOS PAC ID | 1456256874 |
|---|---|
| Medicare Enrollment ID | O20130308000481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811236458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Illinois) | Primary |
Family Health Associates Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 60 Regency Pl, Millstadt, IL 62260 Phone: 618-476-3373 Fax: 618-476-1890 |