Provider Demographics
NPI:1326877143
Name:BUREAU COUNTY FAMILY HEALTH
Entity type:Organization
Organization Name:BUREAU COUNTY FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:815-872-5091
Mailing Address - Street 1:526 S BUREAU VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-2046
Mailing Address - Country:US
Mailing Address - Phone:815-872-5091
Mailing Address - Fax:815-872-5092
Practice Address - Street 1:526 S BUREAU VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-2046
Practice Address - Country:US
Practice Address - Phone:815-872-5091
Practice Address - Fax:815-872-5092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF BUREAU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty