Provider Demographics
NPI:1407893787
Name:VILLAGE OF FARINA FAYETTE COUNTY
Entity Type:Organization
Organization Name:VILLAGE OF FARINA FAYETTE COUNTY
Other - Org Name:VILLAGE OF FARINA
Other - Org Type:Other Name
Authorized Official - Title/Position:VILLAGE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-245-2201
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-7967
Practice Address - Street 1:106 S OAK ST
Practice Address - Street 2:
Practice Address - City:FARINA
Practice Address - State:IL
Practice Address - Zip Code:62838-1282
Practice Address - Country:US
Practice Address - Phone:618-245-2201
Practice Address - Fax:618-245-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL52093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2632011OtherBCBS
IL2632011OtherBCBS
IL=========001Medicaid
IL=========OtherHEALTH NET TRICARE