| Prairie Family Medicine And Obstetrics | |
|
122 E Wabash Ave Forrest IL 61741-9369 | |
| (815) 657-8707 | |
| (815) 657-8717 |
| Full Name | Prairie Family Medicine And Obstetrics |
|---|---|
| Speciality | Clinic/Center |
| Location | 122 E Wabash Ave, Forrest, Illinois |
| Authorized Official Name and Position | Matthew Ertel (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2177842601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Family Medicine And Obstetrics 122 E Wabash Ave Forrest IL 61741-9369 Ph: (815) 657-8707 | Prairie Family Medicine And Obstetrics 122 E Wabash Ave Forrest IL 61741-9369 Ph: (815) 657-8707 |
| NPI Number | 1063462976 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 02/04/2022 |
| Medicare PECOS PAC ID | 5092703124 |
|---|---|
| Medicare Enrollment ID | O20090902000107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063462976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Forrest Family Practice Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 122 E Wabash Ave, Forrest, IL 61741 Phone: 815-657-8707 Fax: 815-657-8717 |