Provider Demographics
NPI:1487648234
Name:OFFICE OF COUNTY TREASURER
Entity Type:Organization
Organization Name:OFFICE OF COUNTY TREASURER
Other - Org Name:LEE COUNTY TREASURER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:815-284-3371
Mailing Address - Street 1:309 S GALENA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3090
Mailing Address - Country:US
Mailing Address - Phone:815-284-3371
Mailing Address - Fax:815-288-1811
Practice Address - Street 1:309 S GALENA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3090
Practice Address - Country:US
Practice Address - Phone:815-284-3371
Practice Address - Fax:815-288-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL332400Medicare ID - Type Unspecified