| Southern Illinois University Edwardsville | |
|
601 James R Thompson Blvd Building D, Suite 2015 East Saint Louis IL 62201-1129 | |
| (618) 482-6959 | |
| (618) 482-8311 |
| Full Name | Southern Illinois University Edwardsville |
|---|---|
| Speciality | Clinic/Center |
| Location | 601 James R Thompson Blvd, East Saint Louis, Illinois |
| Authorized Official Name and Position | Ricki Loar (DIRECTOR OF THE WE CARE CLINIC) |
| Authorized Official Contact | 6184826959 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois University Edwardsville 601 James R Thompson Blvd Building D, Suite 2015 East Saint Louis IL 62201-1129 Ph: (618) 482-6959 | Southern Illinois University Edwardsville 601 James R Thompson Blvd Building D, Suite 2015 East Saint Louis IL 62201-1129 Ph: (618) 482-6959 |
| NPI Number | 1104230168 |
|---|---|
| Provider Enumeration Date | 06/18/2014 |
| Last Update Date | 02/26/2019 |
| Medicare PECOS PAC ID | 3173749157 |
|---|---|
| Medicare Enrollment ID | O20140728002465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104230168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Chaney M Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588198246 PECOS PAC ID: 7012282684 Enrollment ID: I20171006001830 |
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