| Promise Healthcare Nfp | |
|
919 W Kirby Ave Champaign IL 61821-5121 | |
| (217) 356-5477 | |
| Not Available |
| Full Name | Promise Healthcare Nfp |
|---|---|
| Speciality | Clinic/Center |
| Location | 919 W Kirby Ave, Champaign, Illinois |
| Authorized Official Name and Position | Jennifer Henry (CEO) |
| Authorized Official Contact | 2174035401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Promise Healthcare Nfp 919 W Kirby Ave Champaign IL 61821-5121 Ph: () - | Promise Healthcare Nfp 919 W Kirby Ave Champaign IL 61821-5121 Ph: (217) 356-5477 |
| NPI Number | 1629828439 |
|---|---|
| Provider Enumeration Date | 03/25/2024 |
| Last Update Date | 06/03/2024 |
| Medicare PECOS PAC ID | 6103071345 |
|---|---|
| Medicare Enrollment ID | O20230922000281 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629828439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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