Provider Demographics
NPI:1033244009
Name:NORRIS CITY HEALTHCARE CLINIC
Entity Type:Organization
Organization Name:NORRIS CITY HEALTHCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAFP
Authorized Official - Phone:618-378-3440
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:NORRIS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62869-0464
Mailing Address - Country:US
Mailing Address - Phone:618-378-3440
Mailing Address - Fax:618-378-3562
Practice Address - Street 1:110 A EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869-1503
Practice Address - Country:US
Practice Address - Phone:618-378-3440
Practice Address - Fax:618-378-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085969207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1679504377OtherMEDICARE
IL09727246OtherBCBS
IL560595710OtherCOM
IL1679504377OtherMEDICARE
IL1679504377OtherMEDICARE
IL560595710OtherCOM