Organization
NATIONWIDE MEDICAL NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEAL HANNAH (MANAGING DIRECTOR)
(618) 477-9640
Entity
Organization
Contact information
Practice address
4020 GREEN MOUNT CROSSING DR, O FALLON, IL 62269-7287
(618) 477-9640
Mailing address
4020 GREEN MOUNT CROSSING DR STE 143, SHILOH, IL 62269-7287
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
10/29/2021
Last updated
10/29/2021
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