Provider Demographics
NPI:1740431964
Name:SCHUIYLER COUNTY HOSPITAL DISTRICT HEALTH CENTER INC
Entity Type:Organization
Organization Name:SCHUIYLER COUNTY HOSPITAL DISTRICT HEALTH CENTER INC
Other - Org Name:COMMUNITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GADBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-322-5296
Mailing Address - Street 1:135 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61501-9634
Mailing Address - Country:US
Mailing Address - Phone:309-329-2926
Mailing Address - Fax:309-329-2656
Practice Address - Street 1:135 W BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:IL
Practice Address - Zip Code:61501-9634
Practice Address - Country:US
Practice Address - Phone:309-329-2926
Practice Address - Fax:309-329-2656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHUYLER COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL639771Medicare PIN