Provider Demographics
NPI:1013262914
Name:BOARD MEMBERS-CRAWFORD COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:BOARD MEMBERS-CRAWFORD COUNTY GOVERNMENT
Other - Org Name:CRAWFORD COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:CPHA
Authorized Official - Phone:618-544-8798
Mailing Address - Street 1:202 N BLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1264
Mailing Address - Country:US
Mailing Address - Phone:618-544-8798
Mailing Address - Fax:
Practice Address - Street 1:202 N BLINE BLVD
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1264
Practice Address - Country:US
Practice Address - Phone:618-544-8798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Other3RD PARTY BILLING