MEDICARE: FRANKLIN WILLIAMSON BICOUNTY HEALTH DEPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1001437	IL

General Provider Information

NPI Number	:	1326041294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANKLIN WILLIAMSON BICOUNTY HEALTH DEPT

Provider Business Mailing Address
First Line	:	8160 EXPRESS DR
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959
Country	:	US
Telephone Number	:	618-993-8111
Fax Number	:	618-993-6455

Provider Business Practice Location Address
First Line	:	8160 EXPRESS DR
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959
Country	:	US
Telephone Number	:	618-993-8111
Fax Number	:	618-993-6455

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TONY MCENTIRE
Credential	:	M.S.
Telephone Number	:	618-993-8111

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/23/2016

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