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General NPI Number Information
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NPI Number | 1295874576
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Entity Type | Organization
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Legal Business Name | MONROE RANDOLPH BI-COUNTY HEALTH DEPARTMENT
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2515 STATE ST
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City | CHESTER
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State | IL
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Zip | 62233-1149
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Country | US
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Telephone | 618-826-5007
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Fax | 618-826-5223
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Provider Business Mailing Address
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Address Line | 2515 STATE ST
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City | CHESTER
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State | IL
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Zip | 62233-1149
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Country | US
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Telephone | 618-826-5007
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Fax | 618-826-5223
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. THOMAS G SMITH
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Credential | M.P.A.
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Telephone | 618-826-5007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | IL
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