{
"Npi": {
"NPI": "1720687841",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "205 OAKLAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARLINVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62626-1921",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-839-7820",
"MailingAddressFaxNumber": "217-839-1538",
"FirstLinePracticeLocationAddress": "805 SAINT FRANCIS WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LITCHFIELD",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62056-1779",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-839-4141",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/20/2020",
"LastUpdateDate": "03/10/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLANK",
"AuthorizedOfficialFirstName": "CHRISTY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "219-930-2283",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QF0400X",
"TaxonomyName": "Federally Qualified Health Center (FQHC)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}