Organization
FAMILY HEALTH CENTER OF EAST CENTRAL ILLINOIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA L SHEPHERD CNP (VICE-PRESIDENT)
(217) 832-2602
Entity
Organization
Contact information
Practice address
117 W MAIN ST, CAMARGO, IL 61919-3312
(217) 832-2602
(217) 832-8358
Mailing address
117 W MAIN ST, CAMARGO, IL 61919-3312
(217) 832-2602
(217) 832-8358
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC9748
RAILROAD MEDICARE
IL
Enumeration date
08/22/2006
Last updated
02/13/2008
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