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General NPI Number Information
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NPI Number | 1538829726
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Entity Type | Organization
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Legal Business Name | COUNTY OF GREENE
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 310 5TH ST
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City | CARROLLTON
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State | IL
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Zip | 62016-1325
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Country | US
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Telephone | 217-942-6961
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Fax |
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Provider Business Mailing Address
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Address Line | 310 5TH ST
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City | CARROLLTON
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State | IL
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Zip | 62016-1325
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | JAMIE L WAGNER
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Credential |
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Telephone | 217-942-6961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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