Provider Demographics
NPI:1710002589
Name:COUNTY OF CLARK
Entity Type:Organization
Organization Name:COUNTY OF CLARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-826-5721
Mailing Address - Street 1:501 ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-1275
Mailing Address - Country:US
Mailing Address - Phone:217-382-4642
Mailing Address - Fax:217-382-4676
Practice Address - Street 1:501 ARCHER AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-1275
Practice Address - Country:US
Practice Address - Phone:217-382-4642
Practice Address - Fax:217-382-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6-67453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid