Provider Demographics
NPI:1083721567
Name:SPARTA COMMUNITY HOSPITAL D/B/A QUALITY HEALTHCARE CLINICS
Entity Type:Organization
Organization Name:SPARTA COMMUNITY HOSPITAL D/B/A QUALITY HEALTHCARE CLINICS
Other - Org Name:COULTERVILLE MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNSTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-443-2177
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-0297
Mailing Address - Country:US
Mailing Address - Phone:618-443-1337
Mailing Address - Fax:618-443-1383
Practice Address - Street 1:203 E GRANT ST
Practice Address - Street 2:
Practice Address - City:COULTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62237-1623
Practice Address - Country:US
Practice Address - Phone:618-758-2331
Practice Address - Fax:618-758-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143465OtherRHC PROVIDER LOCATION NUM