| Transformative Healthcare Llc | |
|
4 Country Club Executive Park Glen Carbon IL 62034-1702 | |
| (618) 659-5567 | |
| Not Available |
| Full Name | Transformative Healthcare Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4 Country Club Executive Park, Glen Carbon, Illinois |
| Authorized Official Name and Position | Alisha Allen White (PHYSICIAN/OWNER) |
| Authorized Official Contact | 6186595567 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformative Healthcare Llc 4 Country Club Executive Park Glen Carbon IL 62034-1702 Ph: () - | Transformative Healthcare Llc 4 Country Club Executive Park Glen Carbon IL 62034-1702 Ph: (618) 659-5567 |
| NPI Number | 1356849566 |
|---|---|
| Provider Enumeration Date | 01/23/2018 |
| Last Update Date | 02/16/2018 |
| Medicare PECOS PAC ID | 6608137211 |
|---|---|
| Medicare Enrollment ID | O20180222001524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356849566 | NPI | - | NPPES |
| 1467600155 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036121823 (Illinois) | Primary |
| Provider Name | Alisha A White |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467600155 PECOS PAC ID: 4486719028 Enrollment ID: I20110228000402 |
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