Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 105 W. Hack St., Cullom, Illinois |
Authorized Official Name and Position | Robert C Sehring (CEO) |
Authorized Official Contact | 3096552850 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
124 Sw Adams St Peoria IL 61602-1308 Ph: (309) 655-2850 | 105 W. Hack St. Cullom IL 60929 Ph: (800) 589-6070 |
NPI Number | 1790712701 |
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Provider Enumeration Date | 06/26/2006 |
Last Update Date | 03/18/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790712701 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |