MEDICARE: MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC

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
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1568651925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1207 NETWORK CENTRE DR STE 3
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-4632
Country	:	US
Telephone Number	:	217-347-2707
Fax Number	:	217-347-2827

Provider Business Practice Location Address
First Line	:	900 W TEMPLE AVE STE 205
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2187
Country	:	US
Telephone Number	:	217-347-0458
Fax Number	:	217-342-2992

Authorized Official
Title or Position	:	PRESIDENT OF LLC
Name	:	DR. EUGENE P. DUST
Credential	:	M.D.
Telephone Number	:	217-347-5917

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	08/01/2017

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