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410 W Saint Louis St West Frankfort IL 62896-1956 | |
(618) 932-2200 | |
(618) 932-2202 |
Full Name | |
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Speciality | Nurse Practitioner - Family |
Location | 410 W Saint Louis St, West Frankfort, Illinois |
Authorized Official Name and Position | Stacy Gardner (FAMILY NURSE PRACTITIONER/ OWNER) |
Authorized Official Contact | 6189322200 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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410 W Saint Louis St West Frankfort IL 62896-1956 Ph: (618) 932-2200 | 410 W Saint Louis St West Frankfort IL 62896-1956 Ph: (618) 932-2200 |
NPI Number | 1285806422 |
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Provider Enumeration Date | 03/27/2008 |
Last Update Date | 08/17/2009 |
Identifier | Type | State | Issuer |
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1285806422 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 209007026 (Illinois) | Secondary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
Logan Primary Care Service Corp. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 502 W St Louis, West Frankfort, IL 62896 Phone: 618-997-3400 Fax: 618-932-3797 | |