Healthcare Provider Details

I. General information

NPI: 1174277610
Provider Name (Legal Business Name): COUNTY OF TAZEWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21306 STATE ROUTE 9
TREMONT IL
61568-9252
US

IV. Provider business mailing address

21306 STATE ROUTE 9
TREMONT IL
61568-9252
US

V. Phone/Fax

Practice location:
  • Phone: 309-925-5511
  • Fax:
Mailing address:
  • Phone: 309-925-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON RISCH
Title or Position: BILLING COORDINATOR
Credential:
Phone: 309-925-5511