| Nolasco Medical Group, Pllc | |
|
2317 S Bates Ave Springfield IL 62704-4337 | |
| (866) 477-7472 | |
| (217) 717-2268 |
| Full Name | Nolasco Medical Group, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2317 S Bates Ave, Springfield, Illinois |
| Authorized Official Name and Position | Carlos Ernesto Nolasco Morales (PRESIDENT AND CEO) |
| Authorized Official Contact | 8664777472 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nolasco Medical Group, Pllc 2317 S Bates Ave Springfield IL 62704-4337 Ph: (866) 477-7472 | Nolasco Medical Group, Pllc 2317 S Bates Ave Springfield IL 62704-4337 Ph: (866) 477-7472 |
| NPI Number | 1184235905 |
|---|---|
| Provider Enumeration Date | 08/14/2020 |
| Last Update Date | 12/01/2020 |
| Medicare PECOS PAC ID | 1557771144 |
|---|---|
| Medicare Enrollment ID | O20201111000212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184235905 | NPI | - | NPPES |
| F100698048 | Other | IL | MEDICARE PTAN |
| Provider Name | Carlos Ernesto Nolasco Morales |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235484866 PECOS PAC ID: 1456667708 Enrollment ID: I20150901000853 |
| Provider Name | Carmen Orellana Martinez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205191988 PECOS PAC ID: 8527206648 Enrollment ID: I20180818000026 |
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