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General NPI Number Information
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NPI Number | 1093606519
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Entity Type | Organization
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Legal Business Name | RANCHERO CLINIC, LLC
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Dates
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Enumeration Date | 07/12/2025
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 825 18TH ST STE 238
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City | CHARLESTON
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State | IL
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Zip | 61920-2940
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Country | US
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Telephone | 447-219-1594
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Fax | 408-715-5734
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Provider Business Mailing Address
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Address Line | 825 18TH ST STE 238
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City | CHARLESTON
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State | IL
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Zip | 61920-2940
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Country | US
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Telephone | 447-219-1163
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Fax | 408-715-5734
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Authorized Official
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Title or Position | OWNER-PRESIDENT
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Name | DR. BERNIE C RANCHERO
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Credential | MD
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Telephone | 447-219-1163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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