Provider Demographics
NPI:1477742831
Name:MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Other - Org Name:RUNDE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-347-5917
Mailing Address - Street 1:1207 NETWORK CENTRE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4632
Mailing Address - Country:US
Mailing Address - Phone:217-347-2707
Mailing Address - Fax:217-347-2827
Practice Address - Street 1:206 N PEARL
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467
Practice Address - Country:US
Practice Address - Phone:217-857-6481
Practice Address - Fax:217-857-6094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-22
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid
IL=========004Medicaid