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NPI Code Detail

MEDICARE: COUNTY OF LOGAN

MEDICARE: COUNTY OF LOGAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251K00000XPublic Health or Welfare Agency

General Provider Information

NPI Number : 1073762290
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF LOGAN
Provider Business Mailing Address
First Line : 109 3RD ST
Second Line : P.O. BOX 508
City : LINCOLN
State : IL
Zip : 62656-2604
Country : US
Telephone Number : 217-735-2317
Fax Number : 217-732-6943
Provider Business Practice Location Address
First Line : 109 3RD ST
Second Line :
City : LINCOLN
State : IL
Zip : 62656-2604
Country : US
Telephone Number : 217-735-2317
Fax Number : 217-732-6943
Authorized Official
Title or Position : DIRECTOR OF NURSING/ASSISTANT ADMIN
Name : MRS. KARA ANN DAVIS
Credential : RN, BSN
Telephone Number : 217-735-2317
Provider Enumeration Date : 09/11/2008
Last Update Date : 10/19/2015

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Directions to “COUNTY OF LOGAN ” Practice Location

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