| Long Creek Medical Llc | |
|
2550 S 70th St Decatur IL 62521-8742 | |
| (217) 330-0407 | |
| Not Available |
| Full Name | Long Creek Medical Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 2550 S 70th St, Decatur, Illinois |
| Authorized Official Name and Position | Jennifer Shawn Mahannah (OWNER) |
| Authorized Official Contact | 2175193203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Long Creek Medical Llc 2550 S 70th St Decatur IL 62521-8742 Ph: (217) 330-0407 | Long Creek Medical Llc 2550 S 70th St Decatur IL 62521-8742 Ph: (217) 330-0407 |
| NPI Number | 1871345165 |
|---|---|
| Provider Enumeration Date | 04/02/2024 |
| Last Update Date | 10/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871345165 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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