Provider Demographics
NPI:1528130150
Name:COUNTY OF WASHINGTON
Entity type:Organization
Organization Name:COUNTY OF WASHINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREDERKING
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:618-327-3644
Mailing Address - Street 1:177 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1430
Mailing Address - Country:US
Mailing Address - Phone:618-327-3644
Mailing Address - Fax:618-327-4229
Practice Address - Street 1:177 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1430
Practice Address - Country:US
Practice Address - Phone:618-327-3644
Practice Address - Fax:618-327-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002OtherPUBLIC AID
IL=========002OtherPUBLIC AID