Healthcare Provider Details

I. General information

NPI: 1104909407
Provider Name (Legal Business Name): COUNTY OF RICHLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E MAIN ST
OLNEY IL
62450-2114
US

IV. Provider business mailing address

208 E MAIN ST
OLNEY IL
62450-2114
US

V. Phone/Fax

Practice location:
  • Phone: 618-392-6241
  • Fax: 618-393-4078
Mailing address:
  • Phone: 618-392-6241
  • Fax: 618-393-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-189529
License Number StateIL

VIII. Authorized Official

Name: SIDNEY HARRISON
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 618-392-6241