Provider Demographics
NPI:1831294461
Name:JACKSON COUNTY
Entity Type:Organization
Organization Name:JACKSON COUNTY
Other - Org Name:JACKSON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LINK-MULLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-684-3143
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-0307
Mailing Address - Country:US
Mailing Address - Phone:618-684-3143
Mailing Address - Fax:618-684-6023
Practice Address - Street 1:415 HEALTH DEPARTMENT RD
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-6108
Practice Address - Country:US
Practice Address - Phone:618-684-3143
Practice Address - Fax:618-684-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========006Medicaid
IL612290Medicare PIN
IL=========006Medicaid