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750 Broadway Ave E Mattoon IL 61938-4610 | |
| (217) 238-5700 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 750 Broadway Ave E, Mattoon, Illinois |
| Authorized Official Name and Position | Larry Mcculley (CEO) |
| Authorized Official Contact | 6183320694 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2041 Goose Lake Rd Sauget IL 62206-2822 Ph: (618) 332-0953 | 750 Broadway Ave E Mattoon IL 61938-4610 Ph: (217) 238-5700 |
| NPI Number | 1881145357 |
|---|---|
| Provider Enumeration Date | 10/20/2016 |
| Last Update Date | 10/20/2016 |
| Medicare PECOS PAC ID | 1456256874 |
|---|---|
| Medicare Enrollment ID | O20171026001706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881145357 | NPI | - | NPPES |
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