Central Counties Health Centers, INC.
Clinic/Center, Federally Qualified Health Center (FQHC) in Jacksonville, IL. Organization (NPI-2).
NPI number1205282936
StatusActive
Last updated in NPPESMay 19, 2016
Details
- NPI
- 1205282936
- Entity type
- Organization (NPI-2)
- Legal business name
- Central Counties Health Centers, INC.
- Organization subpart
- Yes
- Enumeration date
- May 12, 2016
- Last updated
- May 19, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | – | Yes |
| 207Q00000X | Family Medicine | – | – | |
| 207R00000X | Internal Medicine | – | – | |
| 208000000X | Pediatrics | – | – | |
| 363L00000X | Nurse Practitioner | – | – | |
| 363A00000X | Physician Assistant | – | – | |
| 122300000X | Dentist | – | – | |
| 1041C0700X | Social Worker, Clinical | – | – |
Practice location
1440 W Walnut StSuite 2
Jacksonville, IL 62650-1143
Phone 217-788-2300 · Fax 217-788-2342
Mailing address
2239 E Cook StSpringfield, IL 62703-1944
Phone 217-788-2300 · Fax 217-788-2342
Authorized official
Cindy Kavanagh
Accountant
2177882300
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