| Dieterich Community Medical Center | |
|
203 S. Main St. Dieterich IL 62424 | |
| (217) 925-5730 | |
| (217) 925-5736 |
| Full Name | Dieterich Community Medical Center |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 203 S. Main St., Dieterich, Illinois |
| Authorized Official Name and Position | Eugene P. Dust (PRESIDENT OF MID-ILLINOIS MEDICAL C) |
| Authorized Official Contact | 2173472707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dieterich Community Medical Center 1207 Network Centre Dr Suite 3 Effingham IL 62401-4632 Ph: (217) 347-2707 | Dieterich Community Medical Center 203 S. Main St. Dieterich IL 62424 Ph: (217) 925-5730 |
| NPI Number | 1568619088 |
|---|---|
| Provider Enumeration Date | 08/27/2008 |
| Last Update Date | 06/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568619088 | NPI | - | NPPES |
| 036120332 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 036120332 (Illinois) | Primary |
Hshs Medical Group Family Medicine - Dieterich Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 207 S Main St, Dieterich, IL 62424 Phone: 217-925-5730 |