Provider Demographics
NPI:1912988734
Name:SARAH BUSH LINCOLN HEALTH CENTER
Entity Type:Organization
Organization Name:SARAH BUSH LINCOLN HEALTH CENTER
Other - Org Name:FAYETTE COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-283-5444
Mailing Address - Street 1:650 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1227
Mailing Address - Country:US
Mailing Address - Phone:618-283-5444
Mailing Address - Fax:618-283-1617
Practice Address - Street 1:650 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1227
Practice Address - Country:US
Practice Address - Phone:618-283-1232
Practice Address - Fax:618-283-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000695282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2610276OtherBLUE CROSS PHYSICIAN
IL003667OtherHEALTH ALLIANCE
IL201890414OtherTRICARE
IL0276OtherBLUE CROSS HOSPITAL
ILHEALTHLINKOther102928
IL2610276OtherBLUE CROSS PHYSICIAN