| David J Lane, AUD, CCC-A | |
|
4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864-6293 | |
| (618) 242-0672 | |
| (618) 242-0862 |
| Full Name | David J Lane |
|---|---|
| Gender | Male |
| Speciality | Qualified Audiologist |
| Experience | 26 Years |
| Location | 4117 S Water Tower Pl, Mount Vernon, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164472155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 231H00000X | Audiologist | 147-000854 (Illinois) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Deaconess Illinois Specialty Clinic, Inc. | 9830562016 | 95 |
| Provider Name | David J. Lane, Ltd. |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1821158833 PECOS PAC ID: 5991706756 Enrollment ID: O20070122000133 |
| Provider Name | Deaconess Illinois Specialty Clinic, Inc. |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1972210235 PECOS PAC ID: 9830562016 Enrollment ID: O20230321001688 |
| Mailing Address | Practice Location Address |
|---|---|
| David J Lane, AUD, CCC-A 4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864-6293 Ph: (618) 242-0672 | David J Lane, AUD, CCC-A 4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864-6293 Ph: (618) 242-0672 |
Deaconess Illinois Clinic, Inc Audiologist Medicare: Not Enrolled in Medicare Practice Location: 4117 S Water Tower Pl, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 | |
David J. Lane, Ltd. Audiologist Medicare: Medicare Enrolled Practice Location: 4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 |