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General NPI Number Information
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NPI Number | 1710002589
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Entity Type | Organization
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Legal Business Name | COUNTY OF CLARK
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 501 ARCHER AVE
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City | MARSHALL
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State | IL
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Zip | 62441-1275
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Country | US
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Telephone | 217-382-4642
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Fax | 217-382-4676
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Provider Business Mailing Address
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Address Line | 501 ARCHER AVE
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City | MARSHALL
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State | IL
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Zip | 62441-1275
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Country | US
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Telephone | 217-382-4642
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Fax | 217-382-4676
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Authorized Official
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Title or Position | COUNTY TREASURER
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Name | SHERI HIGGINBOTHAM
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Credential |
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Telephone | 217-826-5721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 6-6745
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License Number State | IL
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