Organization
HERRIN CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH ANN ROBINETTE (OFFICE MANAGER)
(618) 988-9777
Entity
Organization
Contact information
Practice address
220 S PARK AVE, HERRIN, IL 62948
(618) 988-9777
(618) 988-9097
Mailing address
PO BOX 1130, 220 S PARK AVE, HERRIN, IL 62948
(618) 988-9777
(618) 988-9097
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10032030
BCBS
IL
01
—
P00114531
RR MEDICARE
IL
Enumeration date
01/29/2008
Last updated
07/12/2012
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