Healthcare Provider Details

I. General information

NPI: 1164514238
Provider Name (Legal Business Name): SARAH BUSH LINCOLN HEALTH MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLES CENTRE PARKWAY
MATTOON IL
61938-9375
US

IV. Provider business mailing address

1000 HEALTH CENTER DR
MATTOON IL
61938-9253
US

V. Phone/Fax

Practice location:
  • Phone: 217-235-0660
  • Fax: 217-235-0306
Mailing address:
  • Phone: 217-258-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203000594
License Number StateIL

VIII. Authorized Official

Name: DENNIS PLUARD
Title or Position: CFO & VP OF OPERATIONS
Credential:
Phone: 217-258-2513