| Galena Clinic, Inc. | |
|
939 Galena Square Dr Galena IL 61036-1355 | |
| (815) 777-1300 | |
| (815) 777-1308 |
| Full Name | Galena Clinic, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 939 Galena Square Dr, Galena, Illinois |
| Authorized Official Name and Position | Kenneth P Davis (PRESIDENT) |
| Authorized Official Contact | 8157771300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Galena Clinic, Inc. 939 Galena Square Dr Galena IL 61036-1355 Ph: (815) 777-1300 | Galena Clinic, Inc. 939 Galena Square Dr Galena IL 61036-1355 Ph: (815) 777-1300 |
| NPI Number | 1033408356 |
|---|---|
| Provider Enumeration Date | 04/07/2011 |
| Last Update Date | 01/04/2018 |
| Medicare PECOS PAC ID | 2668731142 |
|---|---|
| Medicare Enrollment ID | O20180108001752 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033408356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A-6258-0001-A (Illinois) | Secondary |
| 261QM2800X | Clinic/center - Methadone | A-6258-0001-A (Illinois) | Primary |
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