| The Medaddress, S.c. | |
|
303 E Park Ave Suite 103 Libertyville IL 60048-2872 | |
| (847) 522-7505 | |
| Not Available |
| Full Name | The Medaddress, S.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 303 E Park Ave, Libertyville, Illinois |
| Authorized Official Name and Position | Nina S Maniquis (PRESIDENT) |
| Authorized Official Contact | 8475227505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Medaddress, S.c. 303 E Park Ave Suite 103 Libertyville IL 60048-2872 Ph: (847) 522-7505 | The Medaddress, S.c. 303 E Park Ave Suite 103 Libertyville IL 60048-2872 Ph: (847) 522-7505 |
| NPI Number | 1205075942 |
|---|---|
| Provider Enumeration Date | 02/18/2009 |
| Last Update Date | 11/02/2011 |
| Medicare PECOS PAC ID | 1850444589 |
|---|---|
| Medicare Enrollment ID | O20090728000883 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205075942 | NPI | - | NPPES |
| 042619466 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Vina Maria E Maniquis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851497119 PECOS PAC ID: 6103899166 Enrollment ID: I20041117000464 |
| Provider Name | Nina Socorro E Maniquis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649212010 PECOS PAC ID: 1355244088 Enrollment ID: I20050725000941 |
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