| Bushnell Family Practice | |
|
155 W Hail St Bushnell IL 61422-1346 | |
| (309) 772-9444 | |
| (309) 772-9446 |
| Full Name | Bushnell Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 155 W Hail St, Bushnell, Illinois |
| Authorized Official Name and Position | Brian E Dietz (CEO) |
| Authorized Official Contact | 3098334101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bushnell Family Practice 525 E Grant St Suite 302 Macomb IL 61455-3313 Ph: () - | Bushnell Family Practice 155 W Hail St Bushnell IL 61422-1346 Ph: (309) 772-9444 |
| NPI Number | 1992041511 |
|---|---|
| Provider Enumeration Date | 12/31/2012 |
| Last Update Date | 10/17/2023 |
| Medicare PECOS PAC ID | 0446140180 |
|---|---|
| Medicare Enrollment ID | O20130326000624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992041511 | NPI | - | NPPES |
| 036062336 | Medicaid | IL | |
| 5515957 | Other | IL | BLUE CROSS BLUE SHIELD OF ILLINOIS |
| 148952 | Other | IL | MEDICARE - RURAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Bushnell Family Practice, Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 155 W Hail St, Bushnell, IL 61422 Phone: 309-772-9444 Fax: 309-772-6446 |