Healthcare Provider Details

I. General information

NPI: 1255638862
Provider Name (Legal Business Name): RAMON CLIMACO M D S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S LOCUST ST
ARCOLA IL
61910-1714
US

IV. Provider business mailing address

120 S LOCUST ST
ARCOLA IL
61910-1714
US

V. Phone/Fax

Practice location:
  • Phone: 217-268-4390
  • Fax: 217-268-4936
Mailing address:
  • Phone: 217-268-4390
  • Fax: 217-268-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMON U CLIMACO
Title or Position: DOCTOR/OWNER
Credential: M.D.,S.C.
Phone: 217-268-4390