Provider Demographics
NPI:1336554625
Name:PREFERRED CARE MEDICAL CENTER LTD.
Entity Type:Organization
Organization Name:PREFERRED CARE MEDICAL CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-467-5000
Mailing Address - Street 1:1932 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1666
Mailing Address - Country:US
Mailing Address - Phone:309-467-5000
Mailing Address - Fax:309-467-5100
Practice Address - Street 1:1932 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1666
Practice Address - Country:US
Practice Address - Phone:309-467-5000
Practice Address - Fax:309-467-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010710111N00000X
IL038012330111N00000X
IL036074050364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty