Provider Demographics
NPI:1033386271
Name:FAYETTE COUNTY
Entity Type:Organization
Organization Name:FAYETTE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-283-1044
Mailing Address - Street 1:509 W EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-2707
Mailing Address - Country:US
Mailing Address - Phone:618-283-1044
Mailing Address - Fax:
Practice Address - Street 1:509 W EDWARDS ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-2707
Practice Address - Country:US
Practice Address - Phone:618-283-1044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6247110Medicaid
IL=========6247110Medicaid