Southern Il Regional Wellness Center | |
1736 Kingshighway Washington Park IL 62204-2135 | |
(618) 482-7922 | |
(618) 215-4048 |
Full Name | Southern Il Regional Wellness Center |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 1736 Kingshighway, Washington Park, Illinois |
Authorized Official Name and Position | Mark Freeland (CEO) |
Authorized Official Contact | 6184827922 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Southern Il Regional Wellness Center 1736 Kingshighway Washington Park IL 62204-2135 Ph: (618) 482-7922 | Southern Il Regional Wellness Center 1736 Kingshighway Washington Park IL 62204-2135 Ph: (618) 482-7922 |
NPI Number | 1295194009 |
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Provider Enumeration Date | 02/22/2016 |
Last Update Date | 05/24/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295194009 | NPI | - | NPPES |
1336258540 | Other | IL | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Health And Opportunity Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1835 Kingshighway, Washington Park, IL 62204 Phone: 618-482-7922 Fax: 618-482-7881 |