NPI 1154638021

Lewis Memorial Christian Village

Organisation Preferred Provider Organization Springfield, IL

Practice location

Address: 3400 W Washington St, Springfield, IL 62711-7917
Phone: (217) 787-9600

Authorised official

Name: Laverne Broomfield
Title: Cota
Phone: (217) 787-9600

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 057003241 (IL)

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Registry record

NPI: 1154638021
Entity type: Organization
NPI issued: 13 Sep 2010
Record last updated: 13 Sep 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.