Provider Demographics
NPI:1194223719
Name:SCHUYLER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SCHUYLER COUNTY HOSPITAL DISTRICT
Other - Org Name:COMMUNITY MEDICAL CLINIC OF TABLE GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:S
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:
Mailing Address - Fax:
Practice Address - Street 1:130 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TABLE GROVE
Practice Address - State:IL
Practice Address - Zip Code:61482-9593
Practice Address - Country:US
Practice Address - Phone:309-758-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHUYLER COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-29
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
IL14D2139536OtherCLIA