Basic Information
| Provider Information | |||||||||
| NPI: | 1467951699 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SARAH BUSH LINCOLN HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SARAH BUSH LINCOLN HOME MEDICAL EQUIPMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 COLES CENTRE PKWY | ||||||||
| Address2: | |||||||||
| City: | MATTOON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619389375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172350660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 903 N MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624016401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173477372 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2018 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | PLUARD | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE & CFO | ||||||||
| AuthorizedOfficialTelephone: | 2172582525 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SARAH BUSH LINCOLN HEALTH CENTER | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332B00000X | 203.001989 | IL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.