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105 N Main St Ste 1 Walnut IL 61376-9707 | |
(815) 379-2020 | |
(815) 379-2018 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 105 N Main St Ste 1, Walnut, Illinois |
Authorized Official Name and Position | Jean Welte (MEDICAL STAFF SERVICES COORDINATOR) |
Authorized Official Contact | 8158762293 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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530 Park Ave E Princeton IL 61356-3901 Ph: (815) 876-4419 | 105 N Main St Ste 1 Walnut IL 61376-9707 Ph: (815) 379-2020 |
NPI Number | 1033649967 |
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Provider Enumeration Date | 06/13/2017 |
Last Update Date | 06/15/2020 |
Identifier | Type | State | Issuer |
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1033649967 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | 0001883 (Illinois) | Primary |