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1832 Cleveland Blvd Granite City IL 62040-4500 | |
(618) 397-3303 | |
(618) 397-7802 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1832 Cleveland Blvd, Granite City, Illinois |
Authorized Official Name and Position | Larry Mcculley (COO) |
Authorized Official Contact | 6183320694 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8080 State St East Saint Louis IL 62203-1808 Ph: (618) 397-3303 | 1832 Cleveland Blvd Granite City IL 62040-4500 Ph: (618) 397-3303 |
NPI Number | 1568643260 |
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Provider Enumeration Date | 11/21/2007 |
Last Update Date | 04/20/2008 |
Identifier | Type | State | Issuer |
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1568643260 | NPI | - | NPPES |
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