Provider Demographics
NPI:1124171491
Name:COUNTY OF SCOTT
Entity type:Organization
Organization Name:COUNTY OF SCOTT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-742-8203
Mailing Address - Street 1:335 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-1029
Mailing Address - Country:US
Mailing Address - Phone:217-742-8203
Mailing Address - Fax:217-742-8304
Practice Address - Street 1:335 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-1029
Practice Address - Country:US
Practice Address - Phone:217-742-8203
Practice Address - Fax:217-742-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL240000171001Medicaid
203204Medicare ID - Type Unspecified