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141 Market Pl Ste 100 Fairview Heights IL 62208-2089 | |
| (615) 499-3165 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 141 Market Pl Ste 100, Fairview Heights, Illinois |
| Authorized Official Name and Position | Lev Grinman (CO-OWNER) |
| Authorized Official Contact | 6154993165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
329 S Oyster Bay Rd # 2059 Plainview NY 11803-3301 Ph: () - | 141 Market Pl Ste 100 Fairview Heights IL 62208-2089 Ph: (615) 499-3165 |
| NPI Number | 1023855566 |
|---|---|
| Provider Enumeration Date | 07/11/2024 |
| Last Update Date | 09/19/2024 |
| Medicare PECOS PAC ID | 3870028251 |
|---|---|
| Medicare Enrollment ID | O20241121002976 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023855566 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Marian A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427394485 PECOS PAC ID: 8325288848 Enrollment ID: I20130705000388 |
| Provider Name | Rachel Eb Salazar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033507652 PECOS PAC ID: 3274943402 Enrollment ID: I20201029001229 |
| Provider Name | Ronald Chew |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487104873 PECOS PAC ID: 4688108897 Enrollment ID: I20241111002945 |
| Provider Name | Laura Anne Lengyel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467922708 PECOS PAC ID: 8527593888 Enrollment ID: I20241122001807 |
Fairview Medical Group Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 317 Salem Place, Ste 140, Fairview Heights, IL 62208 Phone: 618-632-3343 Fax: 618-632-4914 | |
Kinetic Health And Performance Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5900 N Illinois St, Fairview Heights, IL 62208 Phone: 618-619-8200 | |
Heartland Medical Center Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5032 N Illinois St, Suite B, Fairview Heights, IL 62208 Phone: 618-416-9005 Fax: 618-641-9452 |