Provider Demographics
NPI:1619213097
Name:INDEPENDENCE HOLDING CO LLC
Entity Type:Organization
Organization Name:INDEPENDENCE HOLDING CO LLC
Other - Org Name:COMPLETE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE V.P.
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-753-1688
Mailing Address - Street 1:14 E WASHINGTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3677
Mailing Address - Country:US
Mailing Address - Phone:217-355-6607
Mailing Address - Fax:217-355-6639
Practice Address - Street 1:14 E WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3677
Practice Address - Country:US
Practice Address - Phone:217-355-6607
Practice Address - Fax:217-355-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-018086332B00000X, 3336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054-018801OtherSTATE LICENSE NUMBER