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One North Monroe Golconda IL 62938 | |
(618) 683-3781 | |
(618) 683-5802 |
Full Name | |
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Speciality | Clinic/Center |
Location | One North Monroe, Golconda, Illinois |
Authorized Official Name and Position | Frederick L Bernstein (CEO) |
Authorized Official Contact | 6184570450 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 3008 Carbondale IL 62902-3008 Ph: (618) 457-0450 | One North Monroe Golconda IL 62938 Ph: (618) 683-3781 |
NPI Number | 1275525735 |
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Provider Enumeration Date | 08/19/2005 |
Last Update Date | 09/01/2010 |
Medicare PECOS PAC ID | 0749194702 |
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Medicare Enrollment ID | O20101014001275 |
Identifier | Type | State | Issuer |
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1275525735 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |