Healthcare Provider Details

I. General information

NPI: 1982771218
Provider Name (Legal Business Name): MASON COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 EAST LAUREL AVENUE
HAVANA IL
62644
US

IV. Provider business mailing address

1002 EAST LAUREL AVENUE
HAVANA IL
62644
US

V. Phone/Fax

Practice location:
  • Phone: 309-543-2201
  • Fax: 309-543-2063
Mailing address:
  • Phone: 309-543-2201
  • Fax: 309-543-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CURT J JIBBEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 309-543-2201