| Tri-state Medical Group Inc | |
|
951 Broadway St Hamilton IL 62341-1436 | |
| (217) 847-2112 | |
| (319) 753-2301 |
| Full Name | Tri-state Medical Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 951 Broadway St, Hamilton, Illinois |
| Authorized Official Name and Position | Antonio Flores (CEO) |
| Authorized Official Contact | 3197685858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-state Medical Group Inc 1706 West Agency Road West Burlington IA 52655 Ph: (319) 768-5858 | Tri-state Medical Group Inc 951 Broadway St Hamilton IL 62341-1436 Ph: (217) 847-2112 |
| NPI Number | 1992784300 |
|---|---|
| Provider Enumeration Date | 01/13/2006 |
| Last Update Date | 01/25/2023 |
| Medicare PECOS PAC ID | 4486562527 |
|---|---|
| Medicare Enrollment ID | O20021216000016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992784300 | NPI | - | NPPES |
| 506089416 | Medicaid | MO | |
| 0563890 | Medicaid | IA | |
| 3422957 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Edward F Mckenney D O S C Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1471 Keokuk St, Hamilton, IL 62341 Phone: 217-847-3383 Fax: 217-847-2832 | |
Gaps Health Il, S.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1599 Keokuk St, Hamilton, IL 62341 Phone: 217-847-3931 Fax: 217-847-2067 |