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General NPI Number Information
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NPI Number | 1174639223
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH CENTER OF EAST CENTRAL ILLINOIS, INC.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 117 W MAIN ST
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City | CAMARGO
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State | IL
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Zip | 61919-3312
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Country | US
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Telephone | 217-832-2602
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Fax | 217-832-8358
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Provider Business Mailing Address
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Address Line | 117 W MAIN ST
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City | CAMARGO
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State | IL
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Zip | 61919-3312
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Country | US
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Telephone | 217-832-2602
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Fax | 217-832-8358
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | LISA L SHEPHERD
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Credential | CNP
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Telephone | 217-832-2602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | IL
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