| Pediatric Group LLC | |
|
3412 Office Park Drive Marion IL 62959-1998 | |
| (618) 993-0404 | |
| (618) 993-1717 |
| Full Name | Pediatric Group LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 3412 Office Park Drive, Marion, Illinois |
| Authorized Official Name and Position | Rhonda Lynn Fisher (CEO) |
| Authorized Official Contact | 6189930404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Group LLC 3412 Office Park Dr Marion IL 62959-6477 Ph: (618) 993-0404 | Pediatric Group LLC 3412 Office Park Drive Marion IL 62959-1998 Ph: (618) 993-0404 |
| NPI Number | 1114129970 |
|---|---|
| Provider Enumeration Date | 06/04/2007 |
| Last Update Date | 04/29/2026 |
| Certification Date | 04/29/2026 |
| Medicare PECOS PAC ID | 7113061292 |
|---|---|
| Medicare Enrollment ID | O20100213000061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114129970 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | () | Primary |
| 208000000X | Pediatrics | () | Secondary |
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