Healthcare Provider Details

I. General information

NPI: 1811946411
Provider Name (Legal Business Name): COUNTY OF CLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 STACEY BURK DR
FLORA IL
62839-3241
US

IV. Provider business mailing address

PO BOX 280
FLORA IL
62839-0280
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-2191
  • Fax: 618-662-1482
Mailing address:
  • Phone: 618-662-2131
  • Fax: 618-662-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CARRIE MILLER
Title or Position: CHIEF NURSING OFFICER
Credential:
Phone: 618-662-2131