Provider Demographics
NPI:1881720175
Name:BURNSIDES COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:BURNSIDES COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDSKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-826-2358
Mailing Address - Street 1:410 N 2ND ST
Mailing Address - Street 2:PO BOX 219
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-1010
Mailing Address - Country:US
Mailing Address - Phone:217-826-2358
Mailing Address - Fax:217-826-2367
Practice Address - Street 1:410 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-1010
Practice Address - Country:US
Practice Address - Phone:217-826-2358
Practice Address - Fax:217-826-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL========= 001OtherSTATE ID
IL=========OtherFEDERAL TAX ID