| Sam Gaines P C | |
|
120 N 11th St Springfield IL 62703-1002 | |
| (217) 544-9858 | |
| Not Available |
| Full Name | Sam Gaines P C |
|---|---|
| Speciality | Internal Medicine |
| Location | 120 N 11th St, Springfield, Illinois |
| Authorized Official Name and Position | Sam Gaines (OWNER) |
| Authorized Official Contact | 2173411726 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sam Gaines P C 509 Colbrook Dr Springfield IL 62702-3384 | Sam Gaines P C 120 N 11th St Springfield IL 62703-1002 Ph: (217) 544-9858 |
| NPI Number | 1487536314 |
|---|---|
| Provider Enumeration Date | 07/22/2025 |
| Last Update Date | 07/22/2025 |
| Certification Date | 07/15/2025 |
| Medicare PECOS PAC ID | 2365939139 |
|---|---|
| Medicare Enrollment ID | O20251015000802 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487536314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Sam Gaines |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730115643 PECOS PAC ID: 3870406861 Enrollment ID: I20040122001131 |
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