Provider Demographics
NPI:1104121326
Name:EGYPTIAN HEALTH DEPARTMENT
Entity type:Organization
Organization Name:EGYPTIAN HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-273-3326
Mailing Address - Street 1:9525 GOLD HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62984
Mailing Address - Country:US
Mailing Address - Phone:618-269-3454
Mailing Address - Fax:618-269-3825
Practice Address - Street 1:9525 GOLD HILL RD
Practice Address - Street 2:
Practice Address - City:SHAWNEETOWN
Practice Address - State:IL
Practice Address - Zip Code:62984-3659
Practice Address - Country:US
Practice Address - Phone:618-269-3454
Practice Address - Fax:618-269-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========006Medicaid