Provider Demographics
NPI:1366534448
Name:SARAH BUSH LINCOLN HEALTH MANAGEMENT SERVICES
Entity type:Organization
Organization Name:SARAH BUSH LINCOLN HEALTH MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-258-2513
Mailing Address - Street 1:1000 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9253
Mailing Address - Country:US
Mailing Address - Phone:217-258-2525
Mailing Address - Fax:
Practice Address - Street 1:903 N MAPLE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401
Practice Address - Country:US
Practice Address - Phone:217-347-7372
Practice Address - Fax:217-347-7574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARAH BUSH LINCOLN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000595332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
1134410002Medicare NSC