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NPI Code Detail

MEDICARE: STEPHEN C PRIEBE PAC

MEDICARE: STEPHEN C PRIEBE PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085001455IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970015885OTHERILMEDICARE RAILROAD

General Provider Information

NPI Number : 1497727937
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN C PRIEBE PAC
Provider Business Mailing Address
First Line : 5383 STATE ROUTE 154
Second Line :
City : PINCKNEYVILLE
State : IL
Zip : 62274-3342
Country : US
Telephone Number : 618-357-2187
Fax Number : 618-357-8888
Provider Business Practice Location Address
First Line : 5383 STATE ROUTE 154
Second Line :
City : PINCKNEYVILLE
State : IL
Zip : 62274-3342
Country : US
Telephone Number : 618-357-2187
Fax Number : 618-357-8888
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 07/11/2023

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Directions to “ STEPHEN C PRIEBE PAC” Practice Location

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