Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 223 E Sixth St, Neoga, Illinois |
Authorized Official Name and Position | Alan Nerone (SENIOR VICE PRESIDENT & CFO) |
Authorized Official Contact | 2175287541 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1025 S 6th St Po Box 19268 Springfield IL 62703-2403 Ph: (217) 528-7541 | 223 E Sixth St Neoga IL 62447 Ph: (217) 895-2320 |
NPI Number | 1972790889 |
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Provider Enumeration Date | 09/25/2007 |
Last Update Date | 07/24/2017 |
Medicare PECOS PAC ID | 0547166076 |
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Medicare Enrollment ID | O20151230000770 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972790889 | NPI | - | NPPES |
PENDING | Other | IL | MEDICARE PART A # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Illinois) | Primary |