Provider Demographics
NPI:1851410880
Name:THOMASBORO CCGS
Entity Type:Organization
Organization Name:THOMASBORO CCGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-643-3275
Mailing Address - Street 1:201 N PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:THOMASBORO
Mailing Address - State:IL
Mailing Address - Zip Code:61878-9784
Mailing Address - Country:US
Mailing Address - Phone:217-643-3275
Mailing Address - Fax:
Practice Address - Street 1:201 N PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:THOMASBORO
Practice Address - State:IL
Practice Address - Zip Code:61878-9784
Practice Address - Country:US
Practice Address - Phone:217-643-3275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health