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General NPI Number Information
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NPI Number | 1588662605
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Entity Type | Organization
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Legal Business Name | EGYPTIAN HEALTH DEPARTMENT
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 1412 US HIGHWAY 45 N
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City | ELDORADO
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State | IL
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Zip | 62930-3766
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Country | US
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Telephone | 618-273-3326
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Fax | 618-273-2808
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Provider Business Mailing Address
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Address Line | 1412 US HIGHWAY 45 N
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City | ELDORADO
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State | IL
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Zip | 62930-3766
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Country | US
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Telephone | 618-273-3326
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Fax | 618-273-2808
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANGIE HAMPTON
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Credential |
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Telephone | 618-273-3326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1002336
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | A-0271-0002-A
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License Number State | IL
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