Provider Demographics
NPI:1669498606
Name:INDEPENDENCE HOLDING CO LLC
Entity Type:Organization
Organization Name:INDEPENDENCE HOLDING CO LLC
Other - Org Name:COMPLETE CARE PHARMACY DOWNTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGROSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-210-9369
Mailing Address - Street 1:201 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1001
Mailing Address - Country:US
Mailing Address - Phone:217-528-8096
Mailing Address - Fax:217-528-8152
Practice Address - Street 1:201 NORTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701
Practice Address - Country:US
Practice Address - Phone:217-528-8096
Practice Address - Fax:217-528-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1476058OtherNABP
IL1476058OtherNABP
IL=========004Medicaid