Healthcare Provider Details

I. General information

NPI: 1407835200
Provider Name (Legal Business Name): ACCESS HEALTHCARE CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 AVENUE OF THE CITIES SUITE 1
EAST MOLINE IL
61244-4110
US

IV. Provider business mailing address

1180 AVENUE OF THE CITIES SUITE 1
EAST MOLINE IL
61244-4110
US

V. Phone/Fax

Practice location:
  • Phone: 309-792-8545
  • Fax: 309-792-8566
Mailing address:
  • Phone: 309-792-8545
  • Fax: 309-792-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JUSTICE AARON GONDWE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 309-792-8545