Healthcare Provider Details

I. General information

NPI: 1912601204
Provider Name (Legal Business Name): DOUGLAS COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E US HIGHWAY 36
TUSCOLA IL
61953-8020
US

IV. Provider business mailing address

1250 E US HIGHWAY 36
TUSCOLA IL
61953-8020
US

V. Phone/Fax

Practice location:
  • Phone: 217-253-4137
  • Fax: 217-599-3854
Mailing address:
  • Phone: 217-253-4137
  • Fax: 217-253-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA MINOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 217-253-4137