Organization
PENNY ATTAWAY
Active
Other names
Medical Services Unlimited
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY ATTAWAY MSN FNP (OWNER, FNP)
(618) 842-5285
Entity
Organization
Contact information
Practice address
1411 W MAIN ST, WESTPORT PLAZA, FAIRFIELD, IL 62837-2300
(618) 842-5285
(618) 842-4576
Mailing address
1411 W MAIN ST, WESTPORT PLAZA, FAIRFIELD, IL 62837-2300
(618) 842-5285
(618) 842-4576
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
209001693
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
385130
MEDICARE B
IL
01
—
9620466
BLUE CROSS BLUE SHIELD
IL
01
—
L040233
TRICARE
IL
Enumeration date
03/23/2007
Last updated
01/19/2009
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