Provider Demographics
NPI:1497889661
Name:COUNTY OF PEORIA
Entity Type:Organization
Organization Name:COUNTY OF PEORIA
Other - Org Name:PEORIA CITY/COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:GULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:309-679-6118
Mailing Address - Street 1:2116 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3457
Mailing Address - Country:US
Mailing Address - Phone:309-679-6118
Mailing Address - Fax:309-679-6610
Practice Address - Street 1:2116 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-3457
Practice Address - Country:US
Practice Address - Phone:309-679-6118
Practice Address - Fax:309-679-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-001Medicaid
IL332340Medicare ID - Type Unspecified