Provider Demographics
NPI:1902977424
Name:MULLIN MEMORIAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MULLIN MEMORIAL HEALTH SERVICES LLC
Other - Org Name:MULLIN MEMORIAL RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESALLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:815-445-2273
Mailing Address - Street 1:320 SOUTH SECOND ST
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:IL
Mailing Address - Zip Code:61338-0324
Mailing Address - Country:US
Mailing Address - Phone:815-445-2273
Mailing Address - Fax:815-445-2213
Practice Address - Street 1:320 SOUTH SECOND ST
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:IL
Practice Address - Zip Code:61338-0324
Practice Address - Country:US
Practice Address - Phone:815-445-2273
Practice Address - Fax:815-445-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health