Wound Clinic Rhc | |
1600 W Walnut St Jacksonville IL 62650-1136 | |
(217) 245-9541 | |
Not Available |
Full Name | Wound Clinic Rhc |
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Speciality | Family Medicine |
Location | 1600 W Walnut St, Jacksonville, Illinois |
Authorized Official Name and Position | Stephen G Lee (PLAN ADMINISTRATOR) |
Authorized Official Contact | 2174795890 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Wound Clinic Rhc 1600 W Walnut St Jacksonville IL 62650-1136 Ph: (217) 245-9541 | Wound Clinic Rhc 1600 W Walnut St Jacksonville IL 62650-1136 Ph: (217) 245-9541 |
NPI Number | 1841578507 |
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Provider Enumeration Date | 07/29/2011 |
Last Update Date | 07/29/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841578507 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 036098965 (Illinois) | Primary |
363LA2200X | Nurse Practitioner - Adult Health | 209007563 (Illinois) | Secondary |
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