MEDICARE: JEFFERSON COUNTY

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
1	251K00000X	Public Health or Welfare Agency		IL

General Provider Information

NPI Number	:	1235253907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON COUNTY

Provider Business Mailing Address
First Line	:	4102 S WATER TOWER PL
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6544
Country	:	US
Telephone Number	:	618-244-7134
Fax Number	:	618-244-2640

Provider Business Practice Location Address
First Line	:	4102 S WATER TOWER PL
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6544
Country	:	US
Telephone Number	:	618-244-7134
Fax Number	:	618-244-2640

Authorized Official
Title or Position	:	ASSISTANT ADMINISTRATOR
Name	:	JESSICA MCDERMOTT
Credential	:
Telephone Number	:	618-244-7134

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	10/30/2024

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Directions to “JEFFERSON COUNTY ” Practice Location

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