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General NPI Number Information
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NPI Number | 1538369277
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Entity Type | Organization
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Legal Business Name | MACOUPIN FAMILY PRACTICE CENTERS, LLP
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 15574 ROUTE 108
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City | CARLINVILLE
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State | IL
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Zip | 62626-4091
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Country | US
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Telephone | 121-785-4431
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Fax |
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Provider Business Mailing Address
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Address Line | 15574 ROUTE 108
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City | CARLINVILLE
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State | IL
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Zip | 62626-4091
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Country | US
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Telephone | 121-785-4431
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRIAN L QUARTON
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Credential |
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Telephone | 217-839-4491
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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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