institution
Penny Attaway
Rural Health Clinic/Center in Fairfield, Illinois
NPI 1184741175

Penny Attaway is a Rural Health Clinic/Center based in Fairfield, IL and is specialized in Rural Health. Penny Attaway practices in Fairfield, IL. The NPI Number for Penny Attaway is 1184741175 and holds a License No. 209001693 (Illinois).

The current practice location address for Penny Attaway is 1411 W Main St, Fairfield, IL and can be reached out via phone at 618-842-5285 and via fax at 618-842-4576.

Location: 1411 W Main St, Fairfield, IL, 62837-2300
institution
Provider Profile Details
NPI Number
1184741175
Provider Name
Penny Attaway
Credential
Provider Entity Type
Organization
Address
1411 W Main St, Fairfield, IL, 62837-2300
Phone Number
618-842-5285
Fax Number
618-842-4576
Provider Enumeration Date
03/23/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
9620466 01 IL BLUE CROSS BLUE SHIELD
L040233 01 IL TRICARE
385130 01 IL MEDICARE B
institution
Provider Business Practice Location Address Details
Address
1411 W Main St
City
State
Zip
62837-2300
Phone Number
618-842-5285
Fax Number
618-842-4576
person
Provider Business Mailing Address Details
Address
1411 W Main St
City
State
Zip
62837-2300
Phone Number
618-842-5285
Fax Number
618-842-4576
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Rural Health
Taxonomy
License No.
209001693 (Illinois)
Definition
Definition to come...
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