Provider Demographics
NPI:1346392024
Name:ILLINI HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ILLINI HEALTH SERVICES, LLC
Other - Org Name:IHS ACQUISITION LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT - FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-223-3197
Mailing Address - Street 1:121 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1317
Mailing Address - Country:US
Mailing Address - Phone:217-285-1914
Mailing Address - Fax:217-285-9433
Practice Address - Street 1:121 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1317
Practice Address - Country:US
Practice Address - Phone:217-285-1914
Practice Address - Fax:217-285-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
028491OtherHEALTH ALLIANCE
561191OtherHEALTHLINK
7515680OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL=========001Medicaid