Provider Demographics
NPI:1720490436
Name:FORD COUNTY
Entity Type:Organization
Organization Name:FORD COUNTY
Other - Org Name:FORD COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:217-379-9281
Mailing Address - Street 1:235 N TAFT ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-1155
Mailing Address - Country:US
Mailing Address - Phone:217-379-9281
Mailing Address - Fax:217-379-2802
Practice Address - Street 1:235 N TAFT ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-1155
Practice Address - Country:US
Practice Address - Phone:217-379-9281
Practice Address - Fax:217-379-2802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORD COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-29
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare