| North Campus | |
|
1300 N Market St Sparta IL 62286-1048 | |
| (618) 443-4138 | |
| (618) 443-2956 |
| Full Name | North Campus |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 N Market St, Sparta, Illinois |
| Authorized Official Name and Position | Lisa Ernsting (CFO) |
| Authorized Official Contact | 6184332177 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Campus Po Box 297 Sparta IL 62286-0297 Ph: (618) 443-1337 | North Campus 1300 N Market St Sparta IL 62286-1048 Ph: (618) 443-4138 |
| NPI Number | 1740395045 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 05/16/2023 |
| Medicare PECOS PAC ID | 6709870462 |
|---|---|
| Medicare Enrollment ID | O20040719000369 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740395045 | NPI | - | NPPES |
| 143464 | Other | IL | RHC LOCATION PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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