| Prairie Trail Family Medicine Sc | |
|
2s661 Angeline Ct Warrenville IL 60555-1301 | |
| (630) 341-1246 | |
| (630) 489-9652 |
| Full Name | Prairie Trail Family Medicine Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 2s661 Angeline Ct, Warrenville, Illinois |
| Authorized Official Name and Position | Pauline N Harding (PRESIDENT) |
| Authorized Official Contact | 6303411246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Trail Family Medicine Sc 2s661 Angeline Ct Warrenville IL 60555-1301 Ph: (630) 341-1246 | Prairie Trail Family Medicine Sc 2s661 Angeline Ct Warrenville IL 60555-1301 Ph: (630) 341-1246 |
| NPI Number | 1003031352 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 02/21/2022 |
| Medicare PECOS PAC ID | 3476965534 |
|---|---|
| Medicare Enrollment ID | O20201214001914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003031352 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 042006514 (Illinois) | Primary |
| Provider Name | Pauline N Harding |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003851692 PECOS PAC ID: 1153470703 Enrollment ID: I20090601000411 |
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