| |
1900 State St Chester IL 62233-1116 | |
(618) 826-2388 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1900 State St, Chester, Illinois |
Authorized Official Name and Position | Morgan Bendorf (CFO) |
Authorized Official Contact | 6188264581 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1900 State St Chester IL 62233-1116 Ph: (618) 826-4581 | 1900 State St Chester IL 62233-1116 Ph: (618) 826-2388 |
NPI Number | 1629469002 |
---|---|
Provider Enumeration Date | 02/06/2015 |
Last Update Date | 10/11/2024 |
Medicare PECOS PAC ID | 5294649372 |
---|---|
Medicare Enrollment ID | O20150414000018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629469002 | NPI | - | NPPES |