Provider Demographics
NPI:1720687841
Name:MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Name:ST FRANCIS WAY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-930-2283
Mailing Address - Street 1:805 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1075
Mailing Address - Country:US
Mailing Address - Phone:217-839-4141
Mailing Address - Fax:
Practice Address - Street 1:805 SAINT FRANCIS WAY
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1779
Practice Address - Country:US
Practice Address - Phone:217-839-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)