Healthcare Provider Details

I. General information

NPI: 1871159053
Provider Name (Legal Business Name): MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W WASHINGTON ST STE 1
NEWTON IL
62448-1249
US

IV. Provider business mailing address

1207 NETWORK CENTRE DR STE 3
EFFINGHAM IL
62401-4632
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-0954
  • Fax: 618-783-0958
Mailing address:
  • Phone: 217-347-2707
  • Fax: 217-347-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC BLOEMER
Title or Position: OWNER
Credential: MD
Phone: 618-783-0954