Provider Demographics
NPI:1649423336
Name:PRAIRIE VIEW CARE CENTER OF LEWISTOWN
Entity Type:Organization
Organization Name:PRAIRIE VIEW CARE CENTER OF LEWISTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:217-637-2794
Mailing Address - Street 1:175 E SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61542-1749
Mailing Address - Country:US
Mailing Address - Phone:309-547-2267
Mailing Address - Fax:309-547-2272
Practice Address - Street 1:175 E SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:IL
Practice Address - Zip Code:61542-1749
Practice Address - Country:US
Practice Address - Phone:309-547-2267
Practice Address - Fax:309-547-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0040303332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========801Medicaid