Provider Demographics
NPI:1356410781
Name:COWDEN MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:COWDEN MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:APN CNP
Authorized Official - Phone:217-783-6565
Mailing Address - Street 1:209 E ELM STREET
Mailing Address - Street 2:PO BOX 154
Mailing Address - City:COWDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62422
Mailing Address - Country:US
Mailing Address - Phone:217-783-6565
Mailing Address - Fax:217-783-6577
Practice Address - Street 1:209 E ELM STREET
Practice Address - Street 2:
Practice Address - City:COWDEN
Practice Address - State:IL
Practice Address - Zip Code:62422
Practice Address - Country:US
Practice Address - Phone:217-783-6565
Practice Address - Fax:217-783-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003495261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148993Medicare Oscar/Certification
ILP40703Medicare UPIN