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NPI Code Detail

MEDICARE: RED BUD CLINIC CORP

MEDICARE: RED BUD CLINIC CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1083617609
Entity Type Code : Organization
Provider Name (Legal Business Name) : RED BUD CLINIC CORP
Provider Business Mailing Address
First Line : 325 SPRING ST
Second Line :
City : RED BUD
State : IL
Zip : 62278-1105
Country : US
Telephone Number : 618-282-3831
Fax Number : 618-282-6101
Provider Business Practice Location Address
First Line : 325 SPRING ST
Second Line :
City : RED BUD
State : IL
Zip : 62278-1105
Country : US
Telephone Number : 618-282-3831
Fax Number : 618-282-6101
Authorized Official
Title or Position : SR. DIRECTOR PHYSICIAN REV CYCLE
Name : LAURA J FEY
Credential :
Telephone Number : 615-221-3641
Provider Enumeration Date : 05/27/2005
Last Update Date : 07/07/2023

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Directions to “RED BUD CLINIC CORP ” Practice Location

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