Full Name | |
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Speciality | Clinic/center |
Location | 818 E Broadway St, Sparta, Illinois |
Authorized Official Name and Position | Michael Hayes (BUSINESS OFFICE MANAGER) |
Authorized Official Contact | 6184432177 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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818 E Broadway St Sparta IL 62286-1820 Ph: () - | 818 E Broadway St Sparta IL 62286 Ph: (618) 443-2177 |
NPI Number | 1154626448 |
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Provider Enumeration Date | 01/18/2011 |
Last Update Date | 08/21/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154626448 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |