Healthcare Provider Details

I. General information

NPI: 1558334763
Provider Name (Legal Business Name): HEALTHCARE NETWORK ASSOCIATES OF SANGAMON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST
SPRINGFIELD IL
62781-0001
US

IV. Provider business mailing address

PO BOX 3428
SPRINGFIELD IL
62708-3428
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-7491
  • Fax: 217-757-2021
Mailing address:
  • Phone: 217-757-7491
  • Fax: 217-757-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT T CLARKE
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 217-788-3340