Organization
MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Active
Parent organization
MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Other names
Dieterich Community Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Authorized official
DR. EUGENE P. DUST M.D. (PRESIDENT OF MID-ILLINOIS MEDICAL C)
(217) 347-2707
Entity
Organization
Contact information
Practice address
203 S. MAIN ST., DIETERICH, IL 62424
(217) 925-5730
(217) 925-5736
Mailing address
1207 NETWORK CENTRE DR, SUITE 3, EFFINGHAM, IL 62401-4632
(217) 347-2707
(217) 347-2827
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
036120332
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036120332
—
IL
Enumeration date
08/27/2008
Last updated
06/27/2017
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