Provider Demographics
NPI:1568678944
Name:COUNTY OF ROCK ISLAND
Entity Type:Organization
Organization Name:COUNTY OF ROCK ISLAND
Other - Org Name:ROCK ISLAND COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUTE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:309-558-2800
Mailing Address - Street 1:2112 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5317
Mailing Address - Country:US
Mailing Address - Phone:309-793-1955
Mailing Address - Fax:309-794-7091
Practice Address - Street 1:2112 25TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5317
Practice Address - Country:US
Practice Address - Phone:309-793-1955
Practice Address - Fax:309-794-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-10-31
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=========005Medicaid
IL363940Medicare ID - Type Unspecified