Provider Demographics
NPI:1205857828
Name:COUNTY OF MACON
Entity type:Organization
Organization Name:COUNTY OF MACON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-423-6988
Mailing Address - Street 1:1221 E CONDIT ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-1405
Mailing Address - Country:US
Mailing Address - Phone:217-423-6988
Mailing Address - Fax:
Practice Address - Street 1:1221 E CONDIT ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-1405
Practice Address - Country:US
Practice Address - Phone:217-423-6988
Practice Address - Fax:217-423-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200000115001Medicaid
IL998000Medicare ID - Type UnspecifiedPROVIDER NUMBER