Provider Demographics
NPI:1538380837
Name:COUNTY OF CHRISTIAN
Entity type:Organization
Organization Name:COUNTY OF CHRISTIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-824-4113
Mailing Address - Street 1:902 W SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1213
Mailing Address - Country:US
Mailing Address - Phone:217-824-4113
Mailing Address - Fax:217-824-4380
Practice Address - Street 1:902 W SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1213
Practice Address - Country:US
Practice Address - Phone:217-824-4113
Practice Address - Fax:217-824-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370893399001Medicaid
IL=========002Medicaid
IL370893399001Medicaid
IL370893399001Medicaid