| David J. Lane, Ltd. | |
|
4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864-6293 | |
| (618) 242-0672 | |
| (618) 242-0862 |
| Full Name | David J. Lane, Ltd. |
|---|---|
| Type | Facility |
| Speciality | Audiologist |
| Location | 4117 S Water Tower Pl, Mount Vernon, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821158833 | NPI | - | NPPES |
| 354668512001 | Medicaid | IL | |
| 83222520 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 231H00000X | Audiologist | 147000854 (Illinois) | Primary |
| Provider Name | David J Lane |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1164472155 PECOS PAC ID: 7618978479 Enrollment ID: I20070122000148 |
| Mailing Address | Practice Location Address |
|---|---|
| David J. Lane, Ltd. 4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864-6293 Ph: (618) 242-0672 | David J. Lane, Ltd. 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, AU.D., CCC-A Audiologist Medicare: Accepting Medicare Assignments Practice Location: 4117 S Water Tower Pl, Suite C, Mount Vernon, IL 62864 Phone: 618-242-0672 Fax: 618-242-0862 |