Provider Demographics
NPI:1346368487
Name:SARAH BUSH LINCOLN HEALTH CENTER
Entity Type:Organization
Organization Name:SARAH BUSH LINCOLN HEALTH CENTER
Other - Org Name:ROZA IOFFE MD PEDS CHAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-258-2513
Mailing Address - Street 1:1000 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1411 E ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2529
Practice Address - Country:US
Practice Address - Phone:217-348-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARAH BUSH LINCOLN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty