Provider Demographics
NPI:1851560791
Name:CHAMPAIGN URBANA PUBLIC HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CHAMPAIGN URBANA PUBLIC HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-531-5369
Mailing Address - Street 1:201 W KENYON RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7807
Mailing Address - Country:US
Mailing Address - Phone:217-352-7961
Mailing Address - Fax:217-531-4336
Practice Address - Street 1:201 W KENYON RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7807
Practice Address - Country:US
Practice Address - Phone:217-352-7961
Practice Address - Fax:217-531-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004112Medicaid
IL1801080916Medicaid
IL1002052Medicaid