Willow Oak Medical, Llc | |
100 S Main St Clinton IN 47842-2437 | |
(912) 713-1124 | |
Not Available |
Full Name | Willow Oak Medical, Llc |
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Speciality | Clinic/Center |
Location | 100 S Main St, Clinton, Indiana |
Authorized Official Name and Position | Jeanie M Kent (OWNER) |
Authorized Official Contact | 9127131124 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Willow Oak Medical, Llc Po Box 467 Clinton IN 47842-0467 Ph: (912) 713-1124 | Willow Oak Medical, Llc 100 S Main St Clinton IN 47842-2437 Ph: (912) 713-1124 |
NPI Number | 1366224719 |
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Provider Enumeration Date | 10/19/2023 |
Last Update Date | 11/01/2023 |
Medicare PECOS PAC ID | 1052769627 |
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Medicare Enrollment ID | O20231121002329 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366224719 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Jeanie Kent |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356063705 PECOS PAC ID: 3173909827 Enrollment ID: I20221003002475 |
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