Provider Demographics
NPI:1699778373
Name:COUNTY OF WHITESIDE
Entity type:Organization
Organization Name:COUNTY OF WHITESIDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHA/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-626-2230
Mailing Address - Street 1:1300 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-1005
Mailing Address - Country:US
Mailing Address - Phone:815-626-2230
Mailing Address - Fax:815-626-3729
Practice Address - Street 1:1300 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-1005
Practice Address - Country:US
Practice Address - Phone:815-626-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
600000706OtherRAILROAD RETIREMENT PTAN
IL9825OtherBCBS PROVIDER NUMBER
600000706OtherRAILROAD RETIREMENT PTAN
IL147032Medicare ID - Type UnspecifiedPROVIDER NUMBER
IL=========003Medicaid