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4409 Maine St Ste 100 Quincy IL 62305-5849 | |
(217) 919-9139 | |
(217) 223-0461 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4409 Maine St Ste 100, Quincy, Illinois |
Authorized Official Name and Position | Iris Wesley (CEO) |
Authorized Official Contact | 2175458000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 19639 Springfield IL 62794-9639 Ph: (217) 545-7876 | 4409 Maine St Ste 100 Quincy IL 62305-5849 Ph: (217) 919-9139 |
NPI Number | 1003324260 |
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Provider Enumeration Date | 01/22/2018 |
Last Update Date | 01/09/2025 |
Medicare PECOS PAC ID | 4486667888 |
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Medicare Enrollment ID | O20180403002167 |
Identifier | Type | State | Issuer |
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1003324260 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Blessing Walk-in Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3700 Broadway St, Quincy, IL 62305 Phone: 217-228-1060 | |
Board Of Trustees Of Southern Illinois University Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 205 S 24th St Ste 100, Quincy, IL 62301 Phone: 217-224-9484 Fax: 217-224-7950 |