Provider Demographics
NPI:1619110566
Name:COUNTY OF MONROE
Entity Type:Organization
Organization Name:COUNTY OF MONROE
Other - Org Name:MONROE COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEHRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-939-3871
Mailing Address - Street 1:1315 JAMIE LANE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-5569
Mailing Address - Country:US
Mailing Address - Phone:618-939-3871
Mailing Address - Fax:618-939-4459
Practice Address - Street 1:1315 JAMIE LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-5569
Practice Address - Country:US
Practice Address - Phone:618-939-3871
Practice Address - Fax:618-939-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619110566Medicaid