Monclair Family Practice | |
1000 Eleven S Ste 2b Columbia IL 62236-1079 | |
(618) 281-7010 | |
(949) 543-2846 |
Full Name | Monclair Family Practice |
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Speciality | Family Medicine |
Location | 1000 Eleven S Ste 2b, Columbia, Illinois |
Authorized Official Name and Position | Tami Boren (OWNER/PRESIDENT) |
Authorized Official Contact | 6182817010 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Monclair Family Practice 1000 Eleven S Ste 2b Columbia IL 62236-1079 Ph: (618) 281-7010 | Monclair Family Practice 1000 Eleven S Ste 2b Columbia IL 62236-1079 Ph: (618) 281-7010 |
NPI Number | 1043774342 |
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Provider Enumeration Date | 01/31/2019 |
Last Update Date | 06/23/2024 |
Medicare PECOS PAC ID | 4385076116 |
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Medicare Enrollment ID | O20191118001018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043774342 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Tami Boren |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962804294 PECOS PAC ID: 3375869381 Enrollment ID: I20191118001112 |
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