Provider Demographics
NPI:1043538994
Name:ILLESHEIM HEALTH CLINIC
Entity Type:Organization
Organization Name:ILLESHEIM HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:314-467-5119
Mailing Address - Street 1:CMR 416 BOX C
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09140-9997
Mailing Address - Country:US
Mailing Address - Phone:314-467-5112
Mailing Address - Fax:
Practice Address - Street 1:CMR 416 BOX C
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09140-9997
Practice Address - Country:US
Practice Address - Phone:314-467-5112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA671825261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility