Provider Demographics
NPI:1184689044
Name:SAUK MEDICAL CLINIC
Entity Type:Organization
Organization Name:SAUK MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SPEERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-626-2088
Mailing Address - Street 1:705 W THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081
Mailing Address - Country:US
Mailing Address - Phone:815-626-2088
Mailing Address - Fax:815-626-5837
Practice Address - Street 1:705 W THIRD STREET
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081
Practice Address - Country:US
Practice Address - Phone:815-626-2088
Practice Address - Fax:815-626-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4616734OtherAETNA
01618391OtherBLUE CROSS BLUE SHIELD
4616734OtherAETNA
D14848Medicare UPIN