CHESTNUT HEALTH SYSTEMS INC NPI 1790055952

NPI Information

CHESTNUT HEALTH SYSTEMS, INC is a federally qualified health center (fqhc) clinic center in Bloomington, IL. CHESTNUT HEALTH SYSTEMS, INC NPI is 1790055952. The provider is registered as an organization entity type.
The provider Is Doing Business As Chestnut Family Health Center.

The provider's business location address is:

702 W CHESTNUT ST
BLOOMINGTON, IL
ZIP 61701-814
Phone: (309) 557-1400
Fax: (309) 557-1461

The provider's authorized official is Melissa Lynn Cooper .
The authorized official title is Managed Care Supervisor and has the following contact phone number (309) 820-3535.

The CLIA number assigned to this NPI record is 14D2046146 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/5/2012 and was last updated on 5/12/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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