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NPI Code Detail

MEDICARE: MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC

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
1261QR1300XRural Health Clinic/Center

General Provider Information

NPI Number : 1871159053
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 : 601 W WASHINGTON ST STE 1
Second Line :
City : NEWTON
State : IL
Zip : 62448-1249
Country : US
Telephone Number : 618-783-0954
Fax Number : 618-783-0958
Authorized Official
Title or Position : OWNER
Name : DR. ERIC BLOEMER
Credential : MD
Telephone Number : 618-783-0954
Provider Enumeration Date : 05/14/2019
Last Update Date : 05/14/2019

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Directions to “MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC ” Practice Location

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