Provider Demographics
NPI:1205943347
Name:COUNTY OF JASPER
Entity type:Organization
Organization Name:COUNTY OF JASPER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRETTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-783-8651
Mailing Address - Street 1:204 W JOURDAN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-1931
Mailing Address - Country:US
Mailing Address - Phone:618-783-8651
Mailing Address - Fax:618-783-5812
Practice Address - Street 1:204 W JOURDAN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1931
Practice Address - Country:US
Practice Address - Phone:618-783-8651
Practice Address - Fax:618-783-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
IL651473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL233110OtherPTAN
IL65147OtherIDPH LICENSE
IL233110Medicare ID - Type UnspecifiedPROVIDER NUMBER