| |
727 W Jackson St Vandalia IL 62471-1722 | |
(618) 283-3144 | |
(618) 283-3194 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 727 W Jackson St, Vandalia, Illinois |
Authorized Official Name and Position | Larry Mcculley (CHIEF OPERATIONS OFFICER) |
Authorized Official Contact | 6183320783 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8080 State St East Saint Louis IL 62203-1808 Ph: (618) 397-3303 | 727 W Jackson St Vandalia IL 62471-1722 Ph: (618) 283-3144 |
NPI Number | 1518902006 |
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Provider Enumeration Date | 06/18/2006 |
Last Update Date | 03/05/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518902006 | NPI | - | NPPES |
201518 | Other | IL | WPS MEDICARE GROUP NUMBER |
Brian W Dossett Md Ltd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1029 N 8th St, Vandalia, IL 62471 Phone: 618-283-4469 Fax: 618-283-4794 | |
Kaskaskia Medical Center, Ltd Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1003 N 8th St, Vandalia, IL 62471 Phone: 618-283-4445 Fax: 618-283-4446 | |