Provider Demographics
NPI:1235253907
Name:JEFFERSON COUNTY
Entity Type:Organization
Organization Name:JEFFERSON COUNTY
Other - Org Name:JEFFERSON COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-244-7134
Mailing Address - Street 1:4102 S WATER TOWER PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6544
Mailing Address - Country:US
Mailing Address - Phone:618-244-7134
Mailing Address - Fax:618-244-2640
Practice Address - Street 1:4102 S WATER TOWER PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6544
Practice Address - Country:US
Practice Address - Phone:618-244-7134
Practice Address - Fax:618-244-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILX16780Medicare UPIN