Provider Demographics
NPI:1366504565
Name:CITY OF CLINTON
Entity Type:Organization
Organization Name:CITY OF CLINTON
Other - Org Name:WARNER HOSPITAL AND HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO ADMINSITRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOWRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-935-9571
Mailing Address - Street 1:422 W WHITE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2272
Mailing Address - Country:US
Mailing Address - Phone:217-935-9571
Mailing Address - Fax:217-937-5262
Practice Address - Street 1:422 W WHITE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2272
Practice Address - Country:US
Practice Address - Phone:217-935-9571
Practice Address - Fax:217-937-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001164261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143404Medicare ID - Type UnspecifiedMEDICARE RHC