=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063558328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF VERMILION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 05/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 S COLLEGE ST SUITE A
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61832-6744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-431-2662
-----------------------------------------------------
Fax | 217-431-7483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 S COLLEGE ST SUITE A
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61832-6744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-431-2662
-----------------------------------------------------
Fax | 217-431-7483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCIAL DIRECTOR
-----------------------------------------------------
Name | DONNA J DUNHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-431-2662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 036-063740
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------