Provider Demographics
NPI:1598206682
Name:SARAH BUSH LINCOLN HEALTH CENTER
Entity Type:Organization
Organization Name:SARAH BUSH LINCOLN HEALTH CENTER
Other - Org Name:WINOGRAD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-258-2102
Mailing Address - Street 1:101 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9252
Mailing Address - Country:US
Mailing Address - Phone:217-258-2110
Mailing Address - Fax:
Practice Address - Street 1:101 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9252
Practice Address - Country:US
Practice Address - Phone:217-258-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARAH BUSH LINCOLN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty