| Penny Attaway | |
|
1411 W Main St Westport Plaza Fairfield IL 62837-2300 | |
| (618) 842-5285 | |
| (618) 842-4576 |
| Full Name | Penny Attaway |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1411 W Main St, Fairfield, Illinois |
| Authorized Official Name and Position | Penny Attaway (OWNER, FNP) |
| Authorized Official Contact | 6188425285 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Penny Attaway 1411 W Main St Westport Plaza Fairfield IL 62837-2300 Ph: (618) 842-5285 | Penny Attaway 1411 W Main St Westport Plaza Fairfield IL 62837-2300 Ph: (618) 842-5285 |
| NPI Number | 1184741175 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 01/19/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184741175 | NPI | - | NPPES |
| 9620466 | Other | IL | BLUE CROSS BLUE SHIELD |
| L040233 | Other | IL | TRICARE |
| 385130 | Other | IL | MEDICARE B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 209001693 (Illinois) | Primary |
Southern Illinois Primary Care Associates, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 Nw 11th St, Fairfield, IL 62837 Phone: 618-842-4470 Fax: 618-842-3437 | |
Fairfield Memorial Hospital Association Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 213 Nw 10th St, Suite A, Fairfield, IL 62837 Phone: 618-842-4617 Fax: 618-842-4743 | |
Fairfield Memorial Hospital Association Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 303 Nw 11th St, Fairfield, IL 62837 Phone: 618-842-2611 | |
Southern Illinois Primary Care Associates, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 209 Nw 11th St, Fairfield, IL 62837 Phone: 618-842-4470 Fax: 618-842-3437 |