Healthcare Provider Details

I. General information

NPI: 1104121326
Provider Name (Legal Business Name): EGYPTIAN HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 GOLD HILL RD
SHAWNEETOWN IL
62984-3659
US

IV. Provider business mailing address

9525 GOLD HILL RD
SHAWNEETOWN IL
62984
US

V. Phone/Fax

Practice location:
  • Phone: 618-269-3454
  • Fax: 618-269-3825
Mailing address:
  • Phone: 618-269-3454
  • Fax: 618-269-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANGIE R HAMPTON
Title or Position: CEO
Credential:
Phone: 618-273-3326