| Medmark Treatment Centers Normal | |
|
303 Landmark Dr Ste 2b Normal IL 61761-6164 | |
| (309) 808-2388 | |
| Not Available |
| Full Name | Medmark Treatment Centers Normal |
|---|---|
| Speciality | Clinic/Center |
| Location | 303 Landmark Dr Ste 2b, Normal, Illinois |
| Authorized Official Name and Position | Bruce Jarvie (VP, TREASURER) |
| Authorized Official Contact | 2143793300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medmark Treatment Centers Normal 303 Landmark Dr Suite 2b Normal IL 61761-2153 Ph: (309) 808-2388 | Medmark Treatment Centers Normal 303 Landmark Dr Ste 2b Normal IL 61761-6164 Ph: (309) 808-2388 |
| NPI Number | 1225389638 |
|---|---|
| Provider Enumeration Date | 09/25/2012 |
| Last Update Date | 07/29/2024 |
| Certification Date | 07/29/2024 |
| Medicare PECOS PAC ID | 0345692745 |
|---|---|
| Medicare Enrollment ID | O20250311000075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225389638 | NPI | - | NPPES |
| Provider Name | Thembi a Conner-garcia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629092226 PECOS PAC ID: 3870499536 Enrollment ID: I20031211000973 |
| Provider Name | Audrey L Tanksley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750524518 PECOS PAC ID: 8123277431 Enrollment ID: I20121002000288 |
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