Provider Demographics
NPI:1417002601
Name:ST CLAIR COUNTY ILLINOIS
Entity Type:Organization
Organization Name:ST CLAIR COUNTY ILLINOIS
Other - Org Name:ST CLAIR COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEVOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-825-4413
Mailing Address - Street 1:19 PUBLIC SQ
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1624
Mailing Address - Country:US
Mailing Address - Phone:618-825-4413
Mailing Address - Fax:618-825-4443
Practice Address - Street 1:19 PUBLIC SQ
Practice Address - Street 2:SUITE 150
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1624
Practice Address - Country:US
Practice Address - Phone:618-825-4413
Practice Address - Fax:618-825-4443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CLAIR COUNTY ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid