Select Care Pllc | |
2103 E Washington St Ste 2c Bloomington IL 61701-4365 | |
(309) 808-1450 | |
(949) 561-4829 |
Full Name | Select Care Pllc |
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Speciality | Clinic/Center |
Location | 2103 E Washington St Ste 2c, Bloomington, Illinois |
Authorized Official Name and Position | Shannon Laesch (OWNER) |
Authorized Official Contact | 3098081450 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Select Care Pllc 2103 E Washington St Ste 2c Bloomington IL 61701-4365 Ph: (309) 808-1450 | Select Care Pllc 2103 E Washington St Ste 2c Bloomington IL 61701-4365 Ph: (309) 808-1450 |
NPI Number | 1558947283 |
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Provider Enumeration Date | 03/23/2021 |
Last Update Date | 03/23/2021 |
Medicare PECOS PAC ID | 9335558691 |
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Medicare Enrollment ID | O20210518000240 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558947283 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Shannon L Laesch |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033559802 PECOS PAC ID: 1355360629 Enrollment ID: I20130731000576 |
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