Provider Demographics
NPI:1528042686
Name:COUNTY OF SHELBY
Entity Type:Organization
Organization Name:COUNTY OF SHELBY
Other - Org Name:SHELBY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MELEGA
Authorized Official - Suffix:III
Authorized Official - Credentials:MA, HSA
Authorized Official - Phone:217-774-9555
Mailing Address - Street 1:1700 W SOUTH 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-9510
Mailing Address - Country:US
Mailing Address - Phone:217-774-9555
Mailing Address - Fax:217-774-2355
Practice Address - Street 1:1700 W SOUTH 3RD ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-9510
Practice Address - Country:US
Practice Address - Phone:217-774-9555
Practice Address - Fax:217-774-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid