| Wound Clinic Rhc | |
|
1600 W Walnut St Jacksonville IL 62650-1136 | |
| (217) 245-9541 | |
| Not Available |
| Full Name | Wound Clinic Rhc |
|---|---|
| Speciality | Family Medicine |
| Location | 1600 W Walnut St, Jacksonville, Illinois |
| Authorized Official Name and Position | Stephen G Lee (PLAN ADMINISTRATOR) |
| Authorized Official Contact | 2174795890 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wound Clinic Rhc 1600 W Walnut St Jacksonville IL 62650-1136 Ph: (217) 245-9541 | Wound Clinic Rhc 1600 W Walnut St Jacksonville IL 62650-1136 Ph: (217) 245-9541 |
| NPI Number | 1841578507 |
|---|---|
| Provider Enumeration Date | 07/29/2011 |
| Last Update Date | 07/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841578507 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036098965 (Illinois) | Primary |
| 363LA2200X | Nurse Practitioner - Adult Health | 209007563 (Illinois) | Secondary |
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