Provider Demographics
NPI:1376533513
Name:COUNTY OF EDGAR
Entity Type:Organization
Organization Name:COUNTY OF EDGAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MC FARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DENTAL CLINIC
Authorized Official - Phone:217-465-2212
Mailing Address - Street 1:502 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2352
Mailing Address - Country:US
Mailing Address - Phone:217-465-2212
Mailing Address - Fax:217-465-1121
Practice Address - Street 1:502 SHAW AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2352
Practice Address - Country:US
Practice Address - Phone:217-465-2212
Practice Address - Fax:217-465-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103024Medicaid