Healthcare Provider Details

I. General information

NPI: 1518993930
Provider Name (Legal Business Name): CONSOLIDATED COMMUNITY MEDICAL CENTERS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N MAPLE ST
EFFINGHAM IL
62401-6401
US

IV. Provider business mailing address

901 N MAPLE ST
EFFINGHAM IL
62401-6401
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-2900
  • Fax: 217-347-2922
Mailing address:
  • Phone: 217-347-2900
  • Fax: 217-347-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMINIC CHARLES IMBURGIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 217-347-2900