# CHESTER CLINIC PROFESSIONAL CORP.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHESTER CLINIC PROFESSIONAL CORP.
- **Other names:** Steeleville Family Practice
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104144187
- **Legal business name:** CHESTER CLINIC PROFESSIONAL CORP.
- **Authorized official:** DONNA MARTIN (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (618) 965-3382

## Contact information

- **Practice address:** 602 W SHAWNEETOWN TRL, STEELEVILLE, IL 62288-1126
- **Practice address phone:** (618) 965-3382
- **Mailing address:** 602 W SHAWNEETOWN TRL, STEELEVILLE, IL 62288-1126

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/14/2010
- **Last updated:** 07/26/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 962310 | MEDICARE | — |