Organization
MADISON PARK CHRISTIAN CHURCH
Active
Organization
MADISON PARK CHRISTIAN CHURCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN CHARLES SACKETT D. MIN. (PREACHING MINISTER)
(217) 222-2529
Entity
Organization
Contact information
Practice address
4700 BROADWAY ST, QUINCY, IL 62305-9112
(217) 222-2529
(217) 222-2895
Mailing address
4700 BROADWAY ST, QUINCY, IL 62305-9112
(217) 222-2529
(217) 222-2895
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001320049
BLUE CROSS/BLUE SHIELD
IL
01
—
344905000
MAGELLAN HEALTH SERVICES
IL
Enumeration date
12/05/2007
Last updated
06/18/2008
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