Provider Demographics
NPI:1184655136
Name:COUNTY OF CLAY
Entity Type:Organization
Organization Name:COUNTY OF CLAY
Other - Org Name:CLAY COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-662-2131
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-0280
Mailing Address - Country:US
Mailing Address - Phone:618-662-2131
Mailing Address - Fax:618-662-1482
Practice Address - Street 1:911 STACEY BURK DR
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-3241
Practice Address - Country:US
Practice Address - Phone:618-662-2131
Practice Address - Fax:618-662-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1744965282N00000X
IL1813281282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========401Medicaid
IL=========001Medicaid
IL=========401Medicaid
IL=========001Medicaid
141351Medicare Oscar/Certification