Healthcare Provider Details

I. General information

NPI: 1235224130
Provider Name (Legal Business Name): COUNTY OF EDWARDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 NORTH 5TH STREET
ALBION IL
62806
US

IV. Provider business mailing address

329 N 5TH ST
ALBION IL
62806-1054
US

V. Phone/Fax

Practice location:
  • Phone: 618-445-2615
  • Fax: 618-445-3851
Mailing address:
  • Phone: 618-445-2615
  • Fax: 618-445-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA MCCOY
Title or Position: EDWARDS COUNTY NURSE ADMINISTRATOR
Credential:
Phone: 618-445-2615