| Crossing Healthcare | |
|
320 E Central Ave Decatur IL 62521-4665 | |
| (217) 877-9117 | |
| (217) 330-8770 |
| Full Name | Crossing Healthcare |
|---|---|
| Speciality | Clinic/Center |
| Location | 320 E Central Ave, Decatur, Illinois |
| Authorized Official Name and Position | Tanya R Andricks (EXECUTIVE DIRECTOR/CEO) |
| Authorized Official Contact | 2178779117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossing Healthcare 320 E Central Ave Decatur IL 62521-4665 Ph: (217) 877-9117 | Crossing Healthcare 320 E Central Ave Decatur IL 62521-4665 Ph: (217) 877-9117 |
| NPI Number | 1194794917 |
|---|---|
| Provider Enumeration Date | 03/15/2006 |
| Last Update Date | 12/28/2015 |
| Medicare PECOS PAC ID | 4385625342 |
|---|---|
| Medicare Enrollment ID | O20050126000270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194794917 | NPI | - | NPPES |
| 300961830001 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Kelcie Marler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689393233 PECOS PAC ID: 6103295357 Enrollment ID: I20221209000377 |
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