Provider Demographics
NPI:1073979308
Name:SCHUYLER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SCHUYLER COUNTY HOSPITAL DISTRICT
Other - Org Name:RUSHVILLE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GADBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-322-5296
Mailing Address - Street 1:238 S CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-1465
Mailing Address - Country:US
Mailing Address - Phone:217-322-4321
Mailing Address - Fax:217-322-6459
Practice Address - Street 1:233 S CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1409
Practice Address - Country:US
Practice Address - Phone:217-322-3345
Practice Address - Fax:217-322-6878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHUYLER COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-31
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D1095968OtherCLINICAL LABORATORY IMPROVEMENT AMENDMENTS