Provider Demographics
NPI:1306973961
Name:MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Entity type:Organization
Organization Name:MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-930-2283
Mailing Address - Street 1:205 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1921
Mailing Address - Country:US
Mailing Address - Phone:217-854-3223
Mailing Address - Fax:217-854-3225
Practice Address - Street 1:205 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1921
Practice Address - Country:US
Practice Address - Phone:217-854-3223
Practice Address - Fax:217-854-3225
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL330330251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL330330Medicare PIN