FAMILY HEALTH CENTER OF EAST CENTRAL ILLINOIS, INC. (NPI# 1174639223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174639223 |
| Entity Type | Organization |
| Organization Name | FAMILY HEALTH CENTER OF EAST CENTRAL ILLINOIS, INC. |
| Practice Address |
117 W Main St Camargo IL 61919-3312 |
| Practice Telephone | 2178322602 |
| Practice Fax Number | 2178328358 |
| Mailing Telephone | 2178322602 |
| Mailing Fax Number | 2178328358 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2008-02-13 |
| Authorized Official Name | LISA L SHEPHERD (VICE-PRESIDENT) |
| Authorized Official Telephone | 2178322602 |
| Authorized Official Credential | CNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RAILROAD MEDICARE | DC9748 | 01 |
| Street Address |
117 W MAIN ST |
| City | CAMARGO |
| State | IL |
| Zip Code | 61919-3312 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922112978 | Lisa L Shepherd | Nurse Practitioner | 117 W Main St, Camargo, IL 61919-3312 | 2006-08-18 |
| 1689676033 | Daphne Louise Piercy | Nurse Practitioner | 117 W Main St, Camargo, IL 61919-3312 | 2005-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700277829 | Samantha Hall | Student in an Organized Health Care Education/Training Program | Rr 1 Box 7720, Camargo, OK 73835-9728 | 2015-02-11 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922112978 | Lisa L Shepherd | Nurse Practitioner | 117 W Main St, Camargo, IL 61919-3312 | 2006-08-18 |
| 1689676033 | Daphne Louise Piercy | Nurse Practitioner | 117 W Main St, Camargo, IL 61919-3312 | 2005-08-15 |
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|---|---|---|---|---|
| 1538760277 | Jennifer Michelle Kennedy | Nurse Practitioner | 3006 Lakeview Dr, Metropolis, IL 62960-3119 | 2020-11-07 |
| 1881295541 | Britney Julia Durst | Nurse Practitioner | 5905 N Prospect Rd, Peoria, IL 61614-4311 | 2020-11-07 |
| 1952902884 | Julia Ann Gottschalk | Nurse Practitioner | 1979 Mcdowell Rd, Unit 103, Naperville, IL 60563 | 2020-11-06 |
| 1932700911 | Laura Ivette Portillo | Nurse Practitioner | 2727 N Marmora Ave, Chicago, IL 60639-1219 | 2020-11-05 |
| 1265033385 | Carolle M Derradji | Nurse Practitioner | 3256 W Potomac Ave, Chicago, IL 60651-2411 | 2020-11-04 |
| 1104427293 | Katie Michelle O'halloran | Nurse Practitioner | 5841 S Maryland Ave # E500, Chicago, IL 60637-1443 | 2020-11-04 |
| 1598365140 | Caitlyn Windsor | Nurse Practitioner | 24525 Grange Rd, Geneseo, IL 61254-8429 | 2020-10-31 |
| 1578163515 | Deanna Bassette | Nurse Practitioner | 243 E 31st St Apt 401, Chicago, IL 60616-5212 | 2020-10-29 |
| 1891395745 | Vrunda Shah Patel | Nurse Practitioner | 933 W Van Buren St Apt 502, Chicago, IL 60607-3583 | 2020-10-29 |
| 1346840337 | Catherine Suh | Nurse Practitioner | 1380 Marcy Ln, Wheeling, IL 60090-4422 | 2020-10-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.