Provider Demographics
NPI:1386713899
Name:SARAH BUSH LINCOLN HEALTH CENTER DURABLE MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:SARAH BUSH LINCOLN HEALTH CENTER DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-258-2513
Mailing Address - Street 1:700 BROADWAY AVE E
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 BROADWAY AVE E
Practice Address - Street 2:SUITE 9
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4671
Practice Address - Country:US
Practice Address - Phone:217-258-2591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARAH BUSH LINCOLN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0003392332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0406050001Medicare NSC