Healthcare Provider Details

I. General information

NPI: 1184655136
Provider Name (Legal Business Name): COUNTY OF CLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 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: 618-662-2131
  • Fax: 618-662-1482
Mailing address:
  • Phone: 618-662-2131
  • Fax: 618-662-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1744965
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1813281
License Number StateIL

VIII. Authorized Official

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