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1831 S Main St Eureka IL 61530-1707 | |
(309) 467-3064 | |
(309) 467-5104 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1831 S Main St, Eureka, Illinois |
Authorized Official Name and Position | Hillary Aggertt (ADMINISTRATOR) |
Authorized Official Contact | 3094673064 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1831 S Main St Eureka IL 61530-1707 Ph: (309) 467-3064 | 1831 S Main St Eureka IL 61530-1707 Ph: (309) 467-3064 |
NPI Number | 1598921025 |
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Provider Enumeration Date | 08/04/2008 |
Last Update Date | 07/14/2023 |
Medicare PECOS PAC ID | 4486719473 |
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Medicare Enrollment ID | O20090206000292 |
Identifier | Type | State | Issuer |
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1598921025 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Primary |