Provider Demographics
NPI:1124022785
Name:COUNTY OF MARION
Entity Type:Organization
Organization Name:COUNTY OF MARION
Other - Org Name:MARION COUNTY HEALTH DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:618-548-3878
Mailing Address - Street 1:118 CROSS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1920
Mailing Address - Country:US
Mailing Address - Phone:618-548-3878
Mailing Address - Fax:618-548-9872
Practice Address - Street 1:118 CROSS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1920
Practice Address - Country:US
Practice Address - Phone:618-548-3878
Practice Address - Fax:618-548-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILX16790Medicare UPIN