Provider Demographics
NPI:1326274325
Name:NORRIS CITY HEALTH CLINIC
Entity Type:Organization
Organization Name:NORRIS CITY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOGENDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHHABRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-378-3440
Mailing Address - Street 1:110 EAST MAIN STREET
Mailing Address - Street 2:P O BOX 464
Mailing Address - City:NORRIS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62869
Mailing Address - Country:US
Mailing Address - Phone:618-378-3440
Mailing Address - Fax:
Practice Address - Street 1:110 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869
Practice Address - Country:US
Practice Address - Phone:618-378-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-112433261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL120821814001Medicaid