Organization
COUNTY OF COLES
Active
Other names
City of Charleston
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL A WHITE (COMPTROLLER)
(217) 345-8425
Entity
Organization
Contact information
Practice address
520 JACKSON AVE, CHARLESTON, IL 61920-2030
(217) 345-8425
(217) 345-8427
Mailing address
520 JACKSON AVE, CHARLESTON, IL 61920-2030
(217) 345-8425
(217) 345-8427
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
1746456
IL
3416L0300X
Land Ambulance
Primary
1746457
IL
3416L0300X
Land Ambulance
1746458
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1570757
BLUE CROSS BLUE SHIELD
IL
01
—
P00192459
RAILROAD MEDICARE
IL
Enumeration date
11/28/2006
Last updated
05/14/2026
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