Provider Demographics
NPI:1578666541
Name:WINNEBAGO COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:WINNEBAGO COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J. MAICHLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-720-4210
Mailing Address - Street 1:401 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2014
Mailing Address - Country:US
Mailing Address - Phone:815-720-4000
Mailing Address - Fax:815-720-4001
Practice Address - Street 1:401 DIVISION ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2014
Practice Address - Country:US
Practice Address - Phone:815-720-4000
Practice Address - Fax:815-720-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
ILIL1201Medicare PIN