MEDICARE: CENTRAL COUNTIES HEALTH CENTERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1235287756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL COUNTIES HEALTH CENTERS, INC.

Provider Business Mailing Address
First Line	:	2239 E COOK ST
Second Line	:	HCH - CONTACT MINISTRIES
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-1944
Country	:	US
Telephone Number	:	217-788-2300
Fax Number	:	217-788-2343

Provider Business Practice Location Address
First Line	:	1100 E ADAMS ST
Second Line	:	HCH - CONTACT MINISTRIES
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-1030
Country	:	US
Telephone Number	:	217-788-2300
Fax Number	:	217-788-2343

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	CINDY KAVANAGH
Credential	:
Telephone Number	:	217-788-2300

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/21/2010

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