Provider Demographics
NPI:1578561577
Name:DEWITT-PIATT BI-COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:DEWITT-PIATT BI-COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-935-3427
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:5924 REVERE ROAD
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-0518
Mailing Address - Country:US
Mailing Address - Phone:217-935-3427
Mailing Address - Fax:217-935-9820
Practice Address - Street 1:5924 REVERE ROAD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-0518
Practice Address - Country:US
Practice Address - Phone:217-935-3427
Practice Address - Fax:217-935-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA600002057OtherRAILROAD MEDICARE
600002057OtherRAILROAD MEDICARE B
IL374430Medicare PIN
GA600002057OtherRAILROAD MEDICARE