Organization
INSTACLINIC OF ILLINOIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA M SOHN RN (MANAGER)
(314) 238-1275
Entity
Organization
Contact information
Practice address
2811 HOMER ADAMS PARKWAY, ALTON, IL 62002
(314) 238-1275
(314) 238-1250
Mailing address
10805 SUNSET OFFICE DRIVE, SUITE 300, ST. LOUIS, MO 63127
(314) 238-1275
(314) 238-1250
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
216708
NEW PTAN MASS IMMUNIZER PROVIDER NUMBER
IL
Enumeration date
09/26/2006
Last updated
08/26/2008
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