| NPI | 1346791167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY KAVANAGH Accountant 217-788-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2016-10-17 |