Provider Demographics
NPI:1801895297
Name:WABASH COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:WABASH COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MSLPCPC
Authorized Official - Phone:618-263-3873
Mailing Address - Street 1:1001 NORTH MARKET STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-1945
Mailing Address - Country:US
Mailing Address - Phone:618-253-4970
Mailing Address - Fax:618-263-4337
Practice Address - Street 1:1001 NORTH MARKET STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1945
Practice Address - Country:US
Practice Address - Phone:618-253-4970
Practice Address - Fax:618-263-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL=========003Medicaid