=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487436101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF JO DAVIESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2023
-----------------------------------------------------
Last Update Date | 10/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 S WEST ST
-----------------------------------------------------
City | GALENA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61036-2544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-777-8088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 S WEST ST
-----------------------------------------------------
City | GALENA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61036-2544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-777-8088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TRANSIT DIRECTOR/PCOM
-----------------------------------------------------
Name | NICOLE HERMSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-777-8088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------