Provider Demographics
NPI:1356535397
Name:MED CONTRACT, INC.
Entity type:Organization
Organization Name:MED CONTRACT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-273-2100
Mailing Address - Street 1:113 MAIN STREET
Mailing Address - Street 2:P O BOX 548
Mailing Address - City:RIDGWAY
Mailing Address - State:IL
Mailing Address - Zip Code:62979-0548
Mailing Address - Country:US
Mailing Address - Phone:618-272-3300
Mailing Address - Fax:618-272-3700
Practice Address - Street 1:113 W MAIN
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:IL
Practice Address - Zip Code:62978
Practice Address - Country:US
Practice Address - Phone:618-272-3300
Practice Address - Fax:618-272-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361037154Medicaid
ILK05588OtherMEDICARE ID-TYPE UNSPECIF
ILH26195Medicare UPIN
IL148971Medicare Oscar/Certification
IL148967Medicare PIN
ILK05588OtherMEDICARE ID-TYPE UNSPECIF