Provider Demographics
NPI:1528193299
Name:ANNA CLINIC CORP
Entity Type:Organization
Organization Name:ANNA CLINIC CORP
Other - Org Name:UNION COUNTY SURGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7626
Mailing Address - Street 1:515 N MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1668
Mailing Address - Country:US
Mailing Address - Phone:618-833-2872
Mailing Address - Fax:618-833-2414
Practice Address - Street 1:515 N MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1668
Practice Address - Country:US
Practice Address - Phone:618-833-2872
Practice Address - Fax:618-833-2414
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNA CLINIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214859Medicare PIN