Healthcare Provider Details

I. General information

NPI: 1215317995
Provider Name (Legal Business Name): COUNTY OF CLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 PARK STREET
CISNE IL
62823
US

IV. Provider business mailing address

PO BOX 280
FLORA IL
62839-0280
US

V. Phone/Fax

Practice location:
  • Phone: 618-844-3300
  • Fax:
Mailing address:
  • Phone: 618-662-2131
  • Fax: 618-662-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA MUSGRAVE
Title or Position: CHIEF HUMAN RESOURCES OFFICER
Credential:
Phone: 618-662-2131