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115 N Poplar St Mount Olive IL 62069-1613 | |
(217) 999-4751 | |
(217) 999-2317 |
Full Name | |
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Speciality | Family Medicine |
Location | 115 N Poplar St, Mount Olive, Illinois |
Authorized Official Name and Position | Bruce F Weber (DIRECTOR) |
Authorized Official Contact | 2178394491 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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115 N Poplar St Mount Olive IL 62069-1613 Ph: (217) 999-4751 | 115 N Poplar St Mount Olive IL 62069-1613 Ph: (217) 999-4751 |
NPI Number | 1477743342 |
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Provider Enumeration Date | 07/27/2007 |
Last Update Date | 04/20/2008 |
Identifier | Type | State | Issuer |
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1477743342 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |