Provider Demographics
NPI:1336326677
Name:HERRIN CLINIC LTD
Entity Type:Organization
Organization Name:HERRIN CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBINETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-988-9777
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:220 S PARK AVE
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948
Mailing Address - Country:US
Mailing Address - Phone:618-988-9777
Mailing Address - Fax:618-988-9097
Practice Address - Street 1:220 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948
Practice Address - Country:US
Practice Address - Phone:618-988-9777
Practice Address - Fax:618-988-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10032030OtherBCBS
ILP00114531OtherRR MEDICARE
IL10032030OtherBCBS
IL208597Medicare PIN