| Professional Fees | |
|
2300 N Edward St Decatur IL 62526-4192 | |
| (217) 876-8121 | |
| Not Available |
| Full Name | Professional Fees |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2300 N Edward St, Decatur, Illinois |
| Authorized Official Name and Position | Judi L Harlan (NETWORK DEVELOPMENT AND PARTNERSHIP) |
| Authorized Official Contact | 2175882882 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Fees 2300 N Edwards St Medical Staff Office Decatur IL 62526 Ph: (217) 876-2857 | Professional Fees 2300 N Edward St Decatur IL 62526-4192 Ph: (217) 876-8121 |
| NPI Number | 1477276301 |
|---|---|
| Provider Enumeration Date | 09/26/2022 |
| Last Update Date | 09/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477276301 | NPI | - | NPPES |
| 1164477725 | Other | IL | DMG NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 367500000X | Nurse Anesthetist, Certified Registered | (* (Not Available)) | Secondary |
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