| Sacred Heart Clinic Of Lasalle Inc. | |
|
920 West St Ste 214 Peru IL 61354-2769 | |
| (224) 587-0569 | |
| Not Available |
| Full Name | Sacred Heart Clinic Of Lasalle Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 920 West St Ste 214, Peru, Illinois |
| Authorized Official Name and Position | Amelia Doris Ledbetter (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 5733354715 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Heart Clinic Of Lasalle Inc. 920 West St Ste 214 Peru IL 61354-2769 Ph: (224) 587-0569 | Sacred Heart Clinic Of Lasalle Inc. 920 West St Ste 214 Peru IL 61354-2769 Ph: (224) 587-0569 |
| NPI Number | 1336755941 |
|---|---|
| Provider Enumeration Date | 09/18/2020 |
| Last Update Date | 09/18/2020 |
| Medicare PECOS PAC ID | 4981024437 |
|---|---|
| Medicare Enrollment ID | O20201021002997 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336755941 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Thomas Choorapokayil George |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922448018 PECOS PAC ID: 5294029666 Enrollment ID: I20160808001566 |
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