Provider Demographics
NPI:1235224130
Name:COUNTY OF EDWARDS
Entity Type:Organization
Organization Name:COUNTY OF EDWARDS
Other - Org Name:EDWARDS COUNTY HEALTH OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EDWARDS COUNTY NURSE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-445-2615
Mailing Address - Street 1:329 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806-1054
Mailing Address - Country:US
Mailing Address - Phone:618-445-2615
Mailing Address - Fax:618-445-3851
Practice Address - Street 1:329 NORTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806
Practice Address - Country:US
Practice Address - Phone:618-445-2615
Practice Address - Fax:618-445-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251K00000XAgenciesPublic Health or Welfare
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL330480Medicare ID - Type Unspecified