| Select Care PLLC | |
|
2103 E Washington St Ste 2c Bloomington IL 61701-4365 | |
| (309) 808-1450 | |
| (949) 561-4829 |
| Full Name | Select Care PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 2103 E Washington St Ste 2c, Bloomington, Illinois |
| Authorized Official Name and Position | Shannon Laesch (OWNER) |
| Authorized Official Contact | 3098081450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Select Care PLLC 2103 E Washington St Ste 2c Bloomington IL 61701-4365 Ph: (309) 808-1450 | Select Care PLLC 2103 E Washington St Ste 2c Bloomington IL 61701-4365 Ph: (309) 808-1450 |
| NPI Number | 1558947283 |
|---|---|
| Provider Enumeration Date | 03/23/2021 |
| Last Update Date | 03/23/2021 |
| Certification Date | 03/23/2021 |
| Medicare PECOS PAC ID | 9335558691 |
|---|---|
| Medicare Enrollment ID | O20210518000240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558947283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Shannon L Feldman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033559802 PECOS PAC ID: 1355360629 Enrollment ID: I20130731000576 |
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