| |
235 E Penn Ave Roseville IL 61473-5006 | |
(309) 426-2128 | |
(309) 426-2455 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 235 E Penn Ave, Roseville, Illinois |
Authorized Official Name and Position | Robert C Sehring (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3096552850 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
124 Sw Adams St Peoria IL 61602-1308 Ph: (309) 655-2850 | 235 E Penn Ave Roseville IL 61473-5006 Ph: (309) 426-2128 |
NPI Number | 1730788902 |
---|---|
Provider Enumeration Date | 10/20/2020 |
Last Update Date | 03/18/2024 |
Medicare PECOS PAC ID | 4284541806 |
---|---|
Medicare Enrollment ID | O20201109003031 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730788902 | NPI | - | NPPES |
999 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |