Provider Demographics
NPI:1205282936
Name:CENTRAL COUNTIES HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:CENTRAL COUNTIES HEALTH CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-788-2300
Mailing Address - Street 1:2239 E COOK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-1944
Mailing Address - Country:US
Mailing Address - Phone:217-788-2300
Mailing Address - Fax:217-788-2342
Practice Address - Street 1:1440 W WALNUT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1143
Practice Address - Country:US
Practice Address - Phone:217-788-2300
Practice Address - Fax:217-788-2342
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL COUNTIES HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-12
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty