Basic Information
| Provider Information | |||||||||
| NPI: | 1841489200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DRS. BISHOP AND FLYNN | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1207 NETWORK CENTRE DR STE 3 | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173472707 | ||||||||
| FaxNumber: | 2173472827 | ||||||||
| Practice Location | |||||||||
| Address1: | 512 N MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173477030 | ||||||||
| FaxNumber: | 2173477049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2007 | ||||||||
| LastUpdateDate: | 06/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | DUST | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OF LLC | ||||||||
| AuthorizedOfficialTelephone: | 2173475917 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.