Healthcare Provider Details

I. General information

NPI: 1164448262
Provider Name (Legal Business Name): COUNTY OF SANGAMON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 S GRAND AVE E
SPRINGFIELD IL
62703-2175
US

IV. Provider business mailing address

2833 S GRAND AVE E
SPRINGFIELD IL
62703-2175
US

V. Phone/Fax

Practice location:
  • Phone: 217-535-3100
  • Fax: 217-535-3104
Mailing address:
  • Phone: 217-535-3100
  • Fax: 217-535-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number261QP0905X
License Number StateIL

VIII. Authorized Official

Name: MR. JAMES D STONE
Title or Position: DIRECTOR OF PUBLIC HEALTH
Credential: M.A.
Phone: 217-535-3100