| |
98 Peach Ridge Rd Anna IL 62906-2243 | |
(618) 614-1400 | |
(618) 614-1401 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 98 Peach Ridge Rd, Anna, Illinois |
Authorized Official Name and Position | Warren P Ladner (SENIOR VP CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 6184575200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 3988 Carbondale IL 62902-3988 Ph: (618) 457-5200 | 98 Peach Ridge Rd Anna IL 62906-2243 Ph: (618) 614-1400 |
NPI Number | 1538689062 |
---|---|
Provider Enumeration Date | 06/26/2017 |
Last Update Date | 01/07/2025 |
Medicare PECOS PAC ID | 3678677390 |
---|---|
Medicare Enrollment ID | O20170925000001 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538689062 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Illinois) | Primary |
Hunter Reach Family Medicine, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 98 Peach Ridge Road, Anna, IL 62906 Phone: 618-614-1400 Fax: 618-614-1401 | |