| Pediatric Group LLC | |
|
130 S Lincoln Blvd Centralia IL 62801-3654 | |
| (618) 993-0404 | |
| (618) 993-1717 |
| Full Name | Pediatric Group LLC |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 130 S Lincoln Blvd, Centralia, Illinois |
| Authorized Official Name and Position | Rhonda Lynn Fisher (CEO) |
| Authorized Official Contact | 6189930404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Group LLC 3412 Office Park Dr Marion IL 62959-6477 Ph: (618) 993-0404 | Pediatric Group LLC 130 S Lincoln Blvd Centralia IL 62801-3654 Ph: (618) 993-0404 |
| NPI Number | 1790689123 |
|---|---|
| Provider Enumeration Date | 10/07/2026 |
| Last Update Date | 10/07/2026 |
| Certification Date | 10/07/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790689123 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (NU) | Primary |
| 208000000X | Pediatrics | (NU) | Secondary |
Tom Martin MD SC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 Ml King Dr, Suite 104, Centralia, IL 62801 Phone: 618-532-6330 Fax: 618-532-7227 |
Heartland Women's Healthcare Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 430 N Pleasant Ave, Centralia, IL 62801 Phone: 618-997-5266 |
The Surgery Center of Centralia Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1045 Martin Luther King Dr, Centralia, IL 62801 Phone: 618-532-3110 Fax: 618-532-3110 |
Rajendra R Shroff MD SC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 M L King Dr Ste 101, Centralia, IL 62801 Phone: 618-532-5700 |
Stephen T Ang MD SC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1054 Martin Luther King Dr, Ste 120, Centralia, IL 62801 Phone: 618-532-1688 Fax: 618-436-8081 |
Dr Shrestha MD SC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1050 M L King Dr, Suite 111, Centralia, IL 62801 Phone: 567-868-4507 Fax: 877-397-7287 |