Provider Demographics
NPI:1194720821
Name:INDEPENDENCE HOLDING CO., LLC
Entity type:Organization
Organization Name:INDEPENDENCE HOLDING CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-232-1222
Mailing Address - Street 1:3063 FIAT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5930
Mailing Address - Country:US
Mailing Address - Phone:866-232-1222
Mailing Address - Fax:217-467-8299
Practice Address - Street 1:602 KEOKUK ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1731
Practice Address - Country:US
Practice Address - Phone:217-735-3415
Practice Address - Fax:217-732-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-14414332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1424186OtherNABP NUMBER
1424186OtherNABP NUMBER
IL=========001Medicaid
BG6960276OtherDEA NUMBER