| Shackelford Clinic | |
|
208 S Jackson St Cerro Gordo IL 62501 | |
| (217) 763-5851 | |
| (217) 763-2201 |
| Full Name | Shackelford Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 208 S Jackson St, Cerro Gordo, Illinois |
| Authorized Official Name and Position | William H Shackelford (OWNER) |
| Authorized Official Contact | 2177635851 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shackelford Clinic Po Box 20 Cerro Gordo IL 61818-0020 Ph: (217) 763-5851 | Shackelford Clinic 208 S Jackson St Cerro Gordo IL 62501 Ph: (217) 763-5851 |
| NPI Number | 1326034232 |
|---|---|
| Provider Enumeration Date | 09/26/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326034232 | NPI | - | NPPES |
| 0007423084 | Other | IL | BLUE SHIELD |
| 036034153-2 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Cerro Gordo Rural Health Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 407 South Jackson Street, Suite A, Cerro Gordo, IL 61818 Phone: 217-763-6010 Fax: 217-763-6012 |