MEDICARE: DEWITT-PIATT BI-COUNTY HEALTH DEPARTMENT

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	261QH0100X	Health Service Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	600002057	OTHER	GA	RAILROAD MEDICARE
2	600002057	OTHER		RAILROAD MEDICARE B

General Provider Information

NPI Number	:	1578561577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEWITT-PIATT BI-COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	PO BOX 518
Second Line	:	5924 REVERE ROAD
City	:	CLINTON
State	:	IL
Zip	:	61727-0518
Country	:	US
Telephone Number	:	217-935-3427
Fax Number	:	217-935-9820

Provider Business Practice Location Address
First Line	:	5924 REVERE ROAD
Second Line	:
City	:	CLINTON
State	:	IL
Zip	:	61727-0518
Country	:	US
Telephone Number	:	217-935-3427
Fax Number	:	217-935-9820

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MR. MICHAEL SCHROEDER
Credential	:
Telephone Number	:	217-935-3427

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/14/2022

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