| Dr Shrestha MD SC | |
|
1050 M L King Dr Suite 111 Centralia IL 62801-3060 | |
| (567) 868-4507 | |
| (877) 397-7287 |
| Full Name | Dr Shrestha MD SC |
|---|---|
| Speciality | Clinic/Center |
| Location | 1050 M L King Dr, Centralia, Illinois |
| Authorized Official Name and Position | Niranjan Shrestha (PRESIDENT) |
| Authorized Official Contact | 5678684507 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Shrestha MD SC 605 Sable Dr Centralia IL 62801-4472 Ph: (567) 868-4507 | Dr Shrestha MD SC 1050 M L King Dr Suite 111 Centralia IL 62801-3060 Ph: (567) 868-4507 |
| NPI Number | 1699045740 |
|---|---|
| Provider Enumeration Date | 01/06/2012 |
| Last Update Date | 01/06/2012 |
| Medicare PECOS PAC ID | 3779742986 |
|---|---|
| Medicare Enrollment ID | O20120307000814 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699045740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Illinois) | Primary |
| Provider Name | Niranjan Shrestha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508031758 PECOS PAC ID: 1759437924 Enrollment ID: I20090914000592 |
Tom Martin MD SC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 Ml King Dr, Suite 104, Centralia, IL 62801 Phone: 618-532-6330 Fax: 618-532-7227 |
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