Shawneetown Healthcare Clinic is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Shawneetown, Illinois. The current practice location for Shawneetown Healthcare Clinic is 9525 Gold Hill Road, Shawneetown Health Care Clinic, Shawneetown, Illinois. For appointments, you can reach them via phone at
(618) 269-3815. The mailing address for Shawneetown Healthcare Clinic is Po Box 155, Christopher Greater Area Rural Health Planning Corp, Christopher, Illinois and phone number is (618) 724-2401.
Shawneetown Healthcare Clinic is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1285614867. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(618) 269-3815.
Primary Care Clinic Profile
| Full Name | Shawneetown Healthcare Clinic |
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| Speciality | Clinic/Center |
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| Location | 9525 Gold Hill Road, Shawneetown, Illinois |
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| Authorized Official Name and Position | Kimberly Mitroka (CEO) |
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| Authorized Official Contact | 6187242401 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Shawneetown Healthcare Clinic
Po Box 155
Christopher Greater Area Rural Health Planning Corp
Christopher
IL 62822
Ph: (618) 724-2401 | Shawneetown Healthcare Clinic
9525 Gold Hill Road
Shawneetown Health Care Clinic
Shawneetown
IL 62984
Ph: (618) 269-3815 |
NPI Details:
| NPI Number | 1285614867 |
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| Provider Enumeration Date | 01/19/2006 |
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| Last Update Date | 09/02/2021 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 8224947387 |
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| Medicare Enrollment ID | O20030606000006 |
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Medical Identifiers
Medical identifiers for Shawneetown Healthcare Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1285614867 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Shawneetown Healthcare Clinic acts as a billing entity for following providers:
| Provider Name | Virginia Leigh Mabrey |
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| Provider Type | Practitioner - Clinical Social Worker |
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| Provider Identifiers | NPI Number: 1306160932
PECOS PAC ID: 2769888759
Enrollment ID: I20210830002831 |
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