| Modert Family Practice, Ltd. | |
|
1 Doctors Park Rd Ste C Mount Vernon IL 62864-6251 | |
| (618) 244-1234 | |
| Not Available |
| Full Name | Modert Family Practice, Ltd. |
|---|---|
| Speciality | Family Medicine |
| Location | 1 Doctors Park Rd Ste C, Mount Vernon, Illinois |
| Authorized Official Name and Position | Sara K. Modert (PRESIDENT) |
| Authorized Official Contact | 6182441234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modert Family Practice, Ltd. Po Box 802 Mount Vernon IL 62864-0017 Ph: (618) 244-1234 | Modert Family Practice, Ltd. 1 Doctors Park Rd Ste C Mount Vernon IL 62864-6251 Ph: (618) 244-1234 |
| NPI Number | 1255311700 |
|---|---|
| Provider Enumeration Date | 01/19/2006 |
| Last Update Date | 11/04/2020 |
| Medicare PECOS PAC ID | 3870669617 |
|---|---|
| Medicare Enrollment ID | O20080903000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255311700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Primary |
| Provider Name | Christopher W Modert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477527604 PECOS PAC ID: 3678588175 Enrollment ID: I20081003000091 |
| Provider Name | Sara K Modert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700866258 PECOS PAC ID: 6406922244 Enrollment ID: I20081003000114 |
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