Provider Demographics
NPI:1477858660
Name:CLINTON INTERNAL MEDICINE SERVICES, S.C.
Entity Type:Organization
Organization Name:CLINTON INTERNAL MEDICINE SERVICES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-849-2545
Mailing Address - Street 1:40 CLINTON PLZ
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2100
Mailing Address - Country:US
Mailing Address - Phone:217-935-7600
Mailing Address - Fax:217-935-7603
Practice Address - Street 1:40 CLINTON PLZ
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2100
Practice Address - Country:US
Practice Address - Phone:217-935-7600
Practice Address - Fax:217-935-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDR6833Medicare Oscar/Certification
ILIL5546Medicare PIN