| Sth Rural Health Clinic | |
|
1201 Ricker Drive Salem IL 62881 | |
| (618) 548-9502 | |
| (844) 659-5616 |
| Full Name | Sth Rural Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1201 Ricker Drive, Salem, Illinois |
| Authorized Official Name and Position | James Timpe (PRESIDENT/CEO) |
| Authorized Official Contact | 6185483194 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sth Rural Health Clinic 1201 Ricker Drive Salem IL 62881 Ph: (618) 548-3194 | Sth Rural Health Clinic 1201 Ricker Drive Salem IL 62881 Ph: (618) 548-9502 |
| NPI Number | 1265467195 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 08/01/2024 |
| Medicare PECOS PAC ID | 0840195277 |
|---|---|
| Medicare Enrollment ID | O20071227000397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265467195 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 0002089 (Illinois) | Primary |
| Provider Name | Margaret Chelsea Ann Burris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093395022 PECOS PAC ID: 1850770215 Enrollment ID: I20220615002712 |
| Provider Name | Angela D Betters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295442325 PECOS PAC ID: 8820451263 Enrollment ID: I20230831003369 |
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