| Ultimed Plus | |
|
4117 S Water Tower Pl Suite D Mount Vernon IL 62864-6293 | |
| (618) 242-4848 | |
| (618) 242-4198 |
| Full Name | Ultimed Plus |
|---|---|
| Speciality | Family Medicine |
| Location | 4117 S Water Tower Pl, Mount Vernon, Illinois |
| Authorized Official Name and Position | Charles W Neal (PRESIDENT) |
| Authorized Official Contact | 6182424848 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ultimed Plus 4117 S Water Tower Pl Suite D Mount Vernon IL 62864-6293 Ph: (618) 242-4848 | Ultimed Plus 4117 S Water Tower Pl Suite D Mount Vernon IL 62864-6293 Ph: (618) 242-4848 |
| NPI Number | 1720057730 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 02/12/2016 |
| Medicare PECOS PAC ID | 1153300553 |
|---|---|
| Medicare Enrollment ID | O20040719000859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720057730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036079719 (Illinois) | Primary |
| Provider Name | Charles Neal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053380683 PECOS PAC ID: 6901885227 Enrollment ID: I20040929000295 |
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