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Organization
JEFFERSON STREET CLINIC, SC
Active
Organization
JEFFERSON STREET CLINIC, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY STEPHEN PATTON D.O. (PRESIDENT)
(309) 266-9711
Entity
Organization
Contact information
Practice address
107 E JEFFERSON STREET, MORTON, IL 61550-0180
(309) 266-9711
(309) 266-6322
Mailing address
107 E JEFFERSON ST, PO BOX 180, MORTON, IL 61550-2001
(309) 266-9711
(309) 266-6322
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9015653
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/13/2007
Last updated
09/13/2007
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