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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