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102 N Logan Ave Danville IL 61832-8513 | |
(217) 442-5863 | |
(217) 442-5040 |
Full Name | |
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Speciality | Clinic/Center |
Location | 102 N Logan Ave, Danville, Illinois |
Authorized Official Name and Position | Sabeeha Haque (OWNER/MANAGER) |
Authorized Official Contact | 3125459727 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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102 N Logan Ave Danville IL 61832-8513 Ph: (217) 442-5863 | 102 N Logan Ave Danville IL 61832-8513 Ph: (217) 442-5863 |
NPI Number | 1972937480 |
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Provider Enumeration Date | 09/03/2013 |
Last Update Date | 11/12/2013 |
Medicare PECOS PAC ID | 3476782574 |
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Medicare Enrollment ID | O20140213000960 |
Identifier | Type | State | Issuer |
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1972937480 | NPI | - | NPPES |
3426615776045330 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 036109029 (Illinois) | Primary |
Muhammad Mushtaq Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 W Fairchild St, Suite B, Danville, IL 61832 Phone: 217-431-1100 Fax: 217-431-2900 | |
Vermilion Medical Center Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 West Fairchild Street, Suite A, Danville, IL 61832 Phone: 217-443-3866 Fax: 217-443-0216 | |
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