Healthcare Provider Details

I. General information

NPI: 1144703372
Provider Name (Legal Business Name): CASS COUNTY PUBLIC HEALTH DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WALL ST
BEARDSTOWN IL
62618-2303
US

IV. Provider business mailing address

331 S MAIN ST
VIRGINIA IL
62691-1571
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-2242
  • Fax:
Mailing address:
  • Phone: 217-452-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY ANGELO
Title or Position: ADMINISTRATOR
Credential: RN BSN
Phone: 217-452-3057