| Promed Preferred Il 2 Pllc | |
|
141 Market Pl Ste 100 Fairview Heights IL 62208-2089 | |
| (615) 499-3165 | |
| Not Available |
| Full Name | Promed Preferred Il 2 Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 141 Market Pl Ste 100, Fairview Heights, Illinois |
| Authorized Official Name and Position | Lev Grinman (CO-OWNER) |
| Authorized Official Contact | 6154993165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Promed Preferred Il 2 Pllc 329 S Oyster Bay Rd # 2059 Plainview NY 11803-3301 Ph: () - | Promed Preferred Il 2 Pllc 141 Market Pl Ste 100 Fairview Heights IL 62208-2089 Ph: (615) 499-3165 |
| NPI Number | 1023855566 |
|---|---|
| Provider Enumeration Date | 07/11/2024 |
| Last Update Date | 02/25/2025 |
| Certification Date | 02/25/2025 |
| Medicare PECOS PAC ID | 3870028251 |
|---|---|
| Medicare Enrollment ID | O20241121002976 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023855566 | NPI | - | NPPES |
| Provider Name | Beverley B Watkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568583136 PECOS PAC ID: 9133187438 Enrollment ID: I20050103000352 |
| Provider Name | Karlene Eleanor Goodman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285749077 PECOS PAC ID: 9335132596 Enrollment ID: I20050822000477 |
| Provider Name | Kathleen A Hitpas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700033354 PECOS PAC ID: 9335285808 Enrollment ID: I20091014000347 |
| Provider Name | Stephen J Frazier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538476742 PECOS PAC ID: 6406011352 Enrollment ID: I20120627000729 |
| Provider Name | Ebele N Iloabachie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093050841 PECOS PAC ID: 7113172883 Enrollment ID: I20130626000228 |
| Provider Name | Marian A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427394485 PECOS PAC ID: 8325288848 Enrollment ID: I20130705000388 |
| Provider Name | Shontel M Ray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932593910 PECOS PAC ID: 4789992595 Enrollment ID: I20160318001451 |
| Provider Name | Nicole Boyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710439112 PECOS PAC ID: 1254613201 Enrollment ID: I20170126001883 |
| Provider Name | Julia E Uhring Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629244322 PECOS PAC ID: 5294161162 Enrollment ID: I20200213000019 |
| Provider Name | Rachel Eb Salazar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033507652 PECOS PAC ID: 3274943402 Enrollment ID: I20201029001229 |
| Provider Name | Ronald Chew |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487104873 PECOS PAC ID: 4688108897 Enrollment ID: I20241111002945 |
| Provider Name | Laura Anne Lengyel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467922708 PECOS PAC ID: 8527593888 Enrollment ID: I20241122001807 |
| Provider Name | Melissa Mae Coffey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336626597 PECOS PAC ID: 9133659956 Enrollment ID: I20250210001227 |
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