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 |
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Provider Type | Practitioner - Qualified Audiologist |
Provider Identifiers | NPI Number: 1164472155 PECOS PAC ID: 7618978479 Enrollment ID: I20070122000148 |
Mailing Address | Practice Location Address |
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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 |