| Monclair Family Practice | |
|
1000 Eleven S Ste 2b Columbia IL 62236-1079 | |
| (618) 281-7010 | |
| (949) 543-2846 |
| Full Name | Monclair Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 Eleven S Ste 2b, Columbia, Illinois |
| Authorized Official Name and Position | Tami Boren (OWNER/PRESIDENT) |
| Authorized Official Contact | 6182817010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Monclair Family Practice 1000 Eleven S Ste 2b Columbia IL 62236-1079 Ph: (618) 281-7010 | Monclair Family Practice 1000 Eleven S Ste 2b Columbia IL 62236-1079 Ph: (618) 281-7010 |
| NPI Number | 1043774342 |
|---|---|
| Provider Enumeration Date | 01/31/2019 |
| Last Update Date | 10/06/2019 |
| Medicare PECOS PAC ID | 4385076116 |
|---|---|
| Medicare Enrollment ID | O20191118001018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043774342 | NPI | - | NPPES |
| 502787806001 | Medicaid | IL | |
| 1932127891 | Other | NPI | |
| 1962404294 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tami Boren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962804294 PECOS PAC ID: 3375869381 Enrollment ID: I20191118001112 |
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