Provider Demographics
NPI:1891937967
Name:RANDOLPH COUNTY
Entity Type:Organization
Organization Name:RANDOLPH COUNTY
Other - Org Name:RANDOLPH COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:618-826-5007
Mailing Address - Street 1:2515 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1149
Mailing Address - Country:US
Mailing Address - Phone:618-826-5007
Mailing Address - Fax:618-826-5223
Practice Address - Street 1:2515 STATE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1149
Practice Address - Country:US
Practice Address - Phone:618-826-5007
Practice Address - Fax:618-826-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare