Provider Demographics
NPI:1750682670
Name:COUNTY OF MERCER HOSPITAL
Entity Type:Organization
Organization Name:COUNTY OF MERCER HOSPITAL
Other - Org Name:MERCER COUNTY SPECIALITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-582-5301
Mailing Address - Street 1:1007 NW 3RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1317
Mailing Address - Country:US
Mailing Address - Phone:309-582-5301
Mailing Address - Fax:
Practice Address - Street 1:1007 NW 3RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1317
Practice Address - Country:US
Practice Address - Phone:309-582-5301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MERCER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty