Provider Demographics
NPI:1114910312
Name:PERRY COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:PERRY COUNTY GOVERNMENT
Other - Org Name:PERRY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-357-5371
Mailing Address - Street 1:P.O. BOX 49
Mailing Address - Street 2:907 SOUTH MAIN STREET
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-1700
Mailing Address - Country:US
Mailing Address - Phone:618-357-5371
Mailing Address - Fax:618-357-3190
Practice Address - Street 1:907 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1700
Practice Address - Country:US
Practice Address - Phone:618-357-5371
Practice Address - Fax:618-357-3190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERRY COUNTY GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-24
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1002179251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL248990Medicare PIN
147161Medicare ID - Type Unspecified