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Organization
INDEPENDENT ORDER OF ODD FELLOWS
Active
Organization
INDEPENDENT ORDER OF ODD FELLOWS
Active
Other names
Odd Fellow Rebekah Home
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID UNDERWOOD CPA (EXEC VP, CFO)
(309) 823-7135
Entity
Organization
Contact information
Practice address
201 LAFAYETTE AVE E, MATTOON, IL 61938-4641
(217) 235-5449
(217) 235-0611
Mailing address
115 W JEFFERSON ST, SUITE 401, BLOOMINGTON, IL 61701-3946
(309) 828-4361
(309) 829-5477
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
11/19/2012
Last updated
01/11/2018
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