| |
1800 E Lake Shore Dr Suite T303 Decatur IL 62521-3810 | |
(217) 464-2505 | |
(217) 464-1669 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1800 E Lake Shore Dr, Decatur, Illinois |
Authorized Official Name and Position | Mark D Evard (VP OF REVENUE CYCLE) |
Authorized Official Contact | 2174929651 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
3051 Hollis Dr Springfield IL 62704-7450 Ph: (217) 464-2505 | 1800 E Lake Shore Dr Suite T303 Decatur IL 62521-3810 Ph: (217) 464-2505 |
NPI Number | 1215108139 |
---|---|
Provider Enumeration Date | 03/19/2008 |
Last Update Date | 10/31/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215108139 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Heritage Behavioral Health Center Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 151 N Main St, Decatur, IL 62523 Phone: 217-362-6262 Fax: 217-362-6290 | |
Veteran's Administration Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3035 E Mound Rd, Decatur, IL 62526 Phone: 217-875-2670 Fax: 217-875-2689 | |
Vsr Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 180 W Imboden Dr, Decatur, IL 62521 Phone: 715-207-1134 | |
Heritage Behavioral Health Center Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 243 W Cerro Gordo St, Decatur, IL 62522 Phone: 217-422-3940 | |