Provider Demographics
NPI:1659406163
Name:DOUGLAS COUNTY
Entity Type:Organization
Organization Name:DOUGLAS COUNTY
Other - Org Name:DOUGLAS COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-253-4137
Mailing Address - Street 1:1250 E. US HWY. 36
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953
Mailing Address - Country:US
Mailing Address - Phone:217-253-4137
Mailing Address - Fax:217-253-3922
Practice Address - Street 1:1250 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-8020
Practice Address - Country:US
Practice Address - Phone:217-253-4137
Practice Address - Fax:217-253-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL375810Medicare ID - Type UnspecifiedMEDICARE
IL=========003Medicaid