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801 N Obannon St Raymond IL 62560-5283 | |
(217) 229-3711 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 801 N Obannon St, Raymond, Illinois |
Authorized Official Name and Position | Alan Nerone (SENIOR VICE PRESIDENT & CFO) |
Authorized Official Contact | 2175287541 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1025 S 6th St Springfield IL 62703-2403 Ph: (217) 528-7541 | 801 N Obannon St Raymond IL 62560-5283 Ph: (217) 229-3711 |
NPI Number | 1013255942 |
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Provider Enumeration Date | 01/28/2013 |
Last Update Date | 07/24/2017 |
Medicare PECOS PAC ID | 0547166076 |
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Medicare Enrollment ID | O20130207000004 |
Identifier | Type | State | Issuer |
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1013255942 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |