1518993930 NPI number — CONSOLIDATED COMMUNITY MEDICAL CENTERS, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518993930 NPI number — CONSOLIDATED COMMUNITY MEDICAL CENTERS, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSOLIDATED COMMUNITY MEDICAL CENTERS, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518993930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 N MAPLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EFFINGHAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62401-6401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-347-2900
Provider Business Mailing Address Fax Number:
217-347-2922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 N MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401-6401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-347-2900
Provider Business Practice Location Address Fax Number:
217-347-2922
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IMBURGIA
Authorized Official First Name:
DOMINIC
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
217-347-2900

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08726591 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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