Provider Demographics
NPI:1770613283
Name:WINNEBAGO COUNTY PUBLIC HEALTH
Entity type:Organization
Organization Name:WINNEBAGO COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:641-585-4763
Mailing Address - Street 1:216 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50436-1802
Mailing Address - Country:US
Mailing Address - Phone:641-585-4763
Mailing Address - Fax:
Practice Address - Street 1:216 S 4TH ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-1802
Practice Address - Country:US
Practice Address - Phone:641-585-4763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34690251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34690Medicare UPIN