Provider Demographics
NPI:1568500510
Name:SARAH BUSH LINCOLN HEALTH CENTER
Entity Type:Organization
Organization Name:SARAH BUSH LINCOLN HEALTH CENTER
Other - Org Name:SARAH BUSH LINCOLN FAYETTE COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-283-5444
Mailing Address - Street 1:1442 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1031
Mailing Address - Country:US
Mailing Address - Phone:618-283-0266
Mailing Address - Fax:618-283-0519
Practice Address - Street 1:1442 N 8TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1027
Practice Address - Country:US
Practice Address - Phone:618-283-0266
Practice Address - Fax:618-283-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007886261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371363933002Medicaid
IL148527Medicare Oscar/Certification