Provider Demographics
NPI:1396771077
Name:COUNTY OF EDWARDS
Entity type:Organization
Organization Name:COUNTY OF EDWARDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-445-3201
Mailing Address - Street 1:27 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806-1016
Mailing Address - Country:US
Mailing Address - Phone:618-445-3201
Mailing Address - Fax:618-445-3190
Practice Address - Street 1:27B W ELM ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-1064
Practice Address - Country:US
Practice Address - Phone:618-445-3201
Practice Address - Fax:618-445-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5205341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213222Medicare PIN