Organization
COMMUNITY COLLEGE DISTRICT 536
Active
Other names
Lewis & Clark Family Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE CHAPMAN (PRESIDENT)
(618) 468-4440
Entity
Organization
Contact information
Practice address
5800 GODFREY RD, FOBES 1525, GODFREY, IL 62035-2426
(618) 468-6800
Mailing address
5800 GODFREY RD, GODFREY, IL 62035-2426
(618) 468-4440
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/02/2008
Last updated
02/17/2016
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