| Siu Center For Family Medicine - Decatur | |
|
102 W Kenwood Ave Decatur IL 62526-4368 | |
| (217) 872-3800 | |
| (217) 872-0849 |
| Full Name | Siu Center For Family Medicine - Decatur |
|---|---|
| Speciality | Clinic/Center |
| Location | 102 W Kenwood Ave, Decatur, Illinois |
| Authorized Official Name and Position | Iris Wesley (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2175457876 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Siu Center For Family Medicine - Decatur Po Box 19639 Springfield IL 62794-9639 Ph: (217) 872-3800 | Siu Center For Family Medicine - Decatur 102 W Kenwood Ave Decatur IL 62526-4368 Ph: (217) 872-3800 |
| NPI Number | 1407376338 |
|---|---|
| Provider Enumeration Date | 06/21/2017 |
| Last Update Date | 06/21/2017 |
| Medicare PECOS PAC ID | 4486667888 |
|---|---|
| Medicare Enrollment ID | O20170717002084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407376338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Illinois) | Primary |
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