Provider Demographics
NPI:1861588097
Name:COUNTY OF UNION
Entity type:Organization
Organization Name:COUNTY OF UNION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNTY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-833-2871
Mailing Address - Street 1:204 W MISSISSIPPI ST
Mailing Address - Street 2:PO BOX 37
Mailing Address - City:JONESBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62952-0037
Mailing Address - Country:US
Mailing Address - Phone:618-833-2871
Mailing Address - Fax:618-833-6201
Practice Address - Street 1:204 W MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:IL
Practice Address - Zip Code:62952-0037
Practice Address - Country:US
Practice Address - Phone:618-833-2871
Practice Address - Fax:618-833-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL55125341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590001833OtherRAILROAD MEDICARE
IL9170724OtherBLUE CROSS BLUE SHIELD IL
IL=========001Medicaid
IL9170724OtherBLUE CROSS BLUE SHIELD IL