Provider Demographics
NPI:1013470905
Name:INFINITE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:INFINITE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-980-3150
Mailing Address - Street 1:28 MEADOW RUE DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3141
Mailing Address - Country:US
Mailing Address - Phone:618-980-3150
Mailing Address - Fax:
Practice Address - Street 1:220 EVERGREEN DRIVE
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-6203
Practice Address - Country:US
Practice Address - Phone:618-655-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty