MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC (NPI# 1568619088) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568619088 |
| Entity Type | Organization |
| Organization Name | MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC |
| Other Organization Name | DIETERICH COMMUNITY MEDICAL CENTER |
| Practice Address |
203 S. Main St. Dieterich IL 62424 |
| Mailing Address |
1207 Network Centre Dr Suite 3 Effingham IL 62401-4632 |
| Practice Telephone | 2179255730 |
| Practice Fax Number | 2179255736 |
| Mailing Telephone | 2173472707 |
| Mailing Fax Number | 2173472827 |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2017-06-27 |
| Authorized Official Name | DR. EUGENE P. DUST (PRESIDENT OF MID-ILLINOIS MEDICAL C) |
| Authorized Official Telephone | 2173472707 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
036120332 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036120332 | 05 |
| Other Name | Type Code |
|---|---|
| Dieterich Community Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477742831 | Mid-illinois Medical Care Associates, LLC | Clinic/Center | 206 N Pearl, Teutopolis, IL 62467 | 2007-10-22 |
| 1568651925 | Mid-illinois Medical Care Associates, LLC | Clinic/Center | 900 W Temple Ave Ste 205, Effingham, IL 62401-2187 | 2007-10-22 |
| 1922067289 | Mid-illinois Medical Care Associates, LLC | Family Medicine | 1207 Network Centre Dr, Suite 3, Effingham, IL 62401-4632 | 2006-03-23 |
| 1871159053 | Mid-illinois Medical Care Associates, LLC | Clinic/Center | 601 W Washington St Ste 1, Newton, IL 62448-1249 | 2019-05-14 |
| 1366683252 | Mid-illinois Medical Care Associates, LLC | Clinic/Center | 910 S Van Buren St, Newton, IL 62448-1727 | 2009-03-23 |
| 1841489200 | Mid-illinois Medical Care Associates, LLC | Clinic/Center | 512 N Maple St, Effingham, IL 62401-2005 | 2007-10-22 |
| 1770771024 | Mid-illinois Medical Care Associates, LLC | Clinic/Center | 5 E Cumberland Rd, Altamont, IL 62411-1271 | 2007-10-11 |
| Street Address |
203 S. MAIN ST. |
| City | DIETERICH |
| State | IL |
| Zip Code | 62424 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437600897 | Angela Koester | Occupational Therapy Assistant | 5250 N 100th St, Dieterich, IL 62424 | 2016-10-20 |
| 1598873176 | Dieterich Comm Unit 30 | Local Education Agency (LEA) | 205 S. Pine, Dieterich, IL 62424 | 2006-08-25 |
| 1972892313 | Jennifer Elizabeth Kistner | Nurse Practitioner | 203 S Main St, Dieterich, IL 62424 | 2011-04-06 |
| 1467754622 | Michelle Schnepper | Behavioral Analyst | 308 Prairie Dr, Dieterich, IL 62424-1127 | 2010-11-21 |
| 1750507422 | Stephanie Shadle | Developmental Therapist | 304 Prairie Dr, Dieterich, IL 62424-1127 | 2007-04-18 |
| 1922559897 | Poehlers Pharmacy LLC | Pharmacy | 203 S Main St, Suite A, Dieterich, IL 62424-1128 | 2016-10-17 |
| 1619068061 | Michelle Rae Braddy | Family Medicine | 203 S Main St, Dieterich, IL 62424-1128 | 2006-09-28 |
| 1346694841 | Traci Walk | Physical Therapy Assistant | 20379 E 1100th Ave, Dieterich, IL 62424-2114 | 2016-04-20 |
| 1477967925 | Diana Williams | Physical Therapy Assistant | 20234 E 1000th Ave, Dieterich, IL 62424-2142 | 2014-06-12 |
| 1528134608 | Keli J. Dhom | Physical Therapist | 19460 E 1150th Ave, Dieterich, IL 62424-2150 | 2006-11-28 |
| Find all providers in zip 62424 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396386181 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak St Ste 100, Carbondale, IL 62901-1496 | 2019-10-02 |
| 1043872781 | Mendota Community Hospital | Clinic/Center | 1401 E 12th St Ste 400, Mendota, IL 61342-9216 | 2019-07-02 |
| 1114582913 | Hammond Henry Dist Hospital | Clinic/Center | 203 W Front St, Annawan, IL 61234-7756 | 2019-05-07 |
| 1841763810 | Heartland Women's Healthcare Ltd | Clinic/Center | 24 Veterans Dr, Harrisburg, IL 62946-3320 | 2019-01-02 |
| 1821561895 | Heartland Women's Healthcare Ltd | Clinic/Center | 215 N Logan St Ste A, West Frankfort, IL 62896-2314 | 2019-01-02 |
| 1578040275 | Osf Healthcare System | Clinic/Center | 230 S Exchange St, Galva, IL 61434-1871 | 2018-07-25 |
| 1700380219 | Toofan Medical Holdings, Ltd. | Clinic/Center | 1510 W Springfield Rd Ste A, Taylorville, IL 62568-2764 | 2018-03-20 |
| 1326542903 | Toofan Medical Holdings, Ltd. | Clinic/Center | 1001 Avenue of Mid America Ste 4, Effingham, IL 62401-4634 | 2018-03-20 |
| 1649795659 | Harrisburg Medical Center Inc | Clinic/Center | 3106 Outer Dr Ste 200, Marion, IL 62959-5270 | 2017-08-10 |
| 1588186308 | Wabash General Hospital District | Clinic/Center | 1430 College Dr Ste A, Mount Carmel, IL 62863-2649 | 2017-07-13 |
| Find all providers with the same taxonomy | ||||
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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.