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105 W Hack St Cullom IL 60929-7133 | |
(815) 689-2126 | |
(309) 655-4878 |
Full Name | |
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Speciality | Clinic/Center |
Location | 105 W Hack St, Cullom, Illinois |
Authorized Official Name and Position | Robert C Sehring (CEO, OSF HEALTHCARE SYSTEM) |
Authorized Official Contact | 3096552850 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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124 Sw Adams St Peoria IL 61602-1308 Ph: (309) 655-2850 | 105 W Hack St Cullom IL 60929-7133 Ph: (815) 689-2126 |
NPI Number | 1467178814 |
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Provider Enumeration Date | 10/18/2022 |
Last Update Date | 07/31/2024 |
Medicare PECOS PAC ID | 0648187252 |
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Medicare Enrollment ID | O20221128001465 |
Identifier | Type | State | Issuer |
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1467178814 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |