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Organization
CHESTER CLINIC PROFESSIONAL CORP.
Active
Organization
CHESTER CLINIC PROFESSIONAL CORP.
Active
Parent organization
CHESTER CLINIC PROFESSIONAL CORP.
Other names
Steeleville Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHESTER CLINIC PROFESSIONAL CORP.
Authorized official
DONNA MARTIN (PRACTICE ADMINISTRATOR)
(618) 965-3382
Entity
Organization
Contact information
Practice address
602 W SHAWNEETOWN TRL, STEELEVILLE, IL 62288-1126
(618) 965-3382
Mailing address
602 W SHAWNEETOWN TRL, STEELEVILLE, IL 62288-1126
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
NULL
261QR1300X
Rural Health Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
962310
MEDICARE
—
Enumeration date
05/14/2010
Last updated
07/26/2010
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