Provider Demographics
NPI:1215110903
Name:HAMILTON COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:HAMILTON COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-643-3522
Mailing Address - Street 1:100 N JACKSON
Mailing Address - Street 2:
Mailing Address - City:MCLEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859
Mailing Address - Country:US
Mailing Address - Phone:618-643-3522
Mailing Address - Fax:618-643-2390
Practice Address - Street 1:COURTHOUSE ROOM 5
Practice Address - Street 2:
Practice Address - City:MCLEANSBORO
Practice Address - State:IL
Practice Address - Zip Code:62859
Practice Address - Country:US
Practice Address - Phone:618-643-3522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL330400Medicare PIN