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233 S Congress St Rushville IL 62681-1409 | |
(217) 322-3345 | |
(217) 322-6878 |
Full Name | |
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Speciality | Clinic/Center |
Location | 233 S Congress St, Rushville, Illinois |
Authorized Official Name and Position | Tamra Sue Gadberry (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 2173225296 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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238 S Congress St Rushville IL 62681-1465 Ph: (217) 322-4321 | 233 S Congress St Rushville IL 62681-1409 Ph: (217) 322-3345 |
NPI Number | 1073979308 |
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Provider Enumeration Date | 12/31/2015 |
Last Update Date | 11/09/2020 |
Medicare PECOS PAC ID | 9638076474 |
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Medicare Enrollment ID | O20161027001997 |
Identifier | Type | State | Issuer |
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1073979308 | NPI | - | NPPES |
14D1095968 | Other | IL | CLINICAL LABORATORY IMPROVEMENT AMENDMENTS |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |