Provider Demographics
NPI:1124155841
Name:COUNTY OF MCDONOUGH MCDONOUGH COUNTY CLERK
Entity type:Organization
Organization Name:COUNTY OF MCDONOUGH MCDONOUGH COUNTY CLERK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CLEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-837-9951
Mailing Address - Street 1:505 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2310
Mailing Address - Country:US
Mailing Address - Phone:309-837-9951
Mailing Address - Fax:309-837-1100
Practice Address - Street 1:505 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2310
Practice Address - Country:US
Practice Address - Phone:309-837-9951
Practice Address - Fax:309-837-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336062856251K00000X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL377130Medicare ID - Type Unspecified
377130Medicare PIN