Organization
MACOUPIN COUNTY PUBLIC HEALTH DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY BLANK (CHIEF EXECUTIVE OFFICER)
(217) 930-2283
Entity
Organization
Contact information
Practice address
109 E MAPLE ST, GILLESPIE, IL 62033-1473
(217) 839-1526
(217) 839-1538
Mailing address
205 OAKLAND AVE, CARLINVILLE, IL 62626-1921
(217) 839-7820
(217) 839-1538
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
007
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141154
NGS MEDICARE
IL
Enumeration date
10/18/2011
Last updated
06/27/2023
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