1255499463 NPI number — SOUTHERN SEVEN HEALTH DEPT

Table of content: (NPI 1255499463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255499463 NPI number — SOUTHERN SEVEN HEALTH DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN SEVEN HEALTH DEPT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255499463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 RUSTIC CAMPUS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ULLIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62992-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-634-2297
Provider Business Mailing Address Fax Number:
618-634-9011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 RUSTIC CAMPUS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULLIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62992-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-634-2297
Provider Business Practice Location Address Fax Number:
618-634-9011
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS-RAY
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
618-634-2297

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 600001850 . This is a "RAILROAD MEDICARE-MASSAC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 600001853 . This is a "RAILROAD MEDICARE-POPE CO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 600001837 . This is a "RAILROAD MEDICARE-ALEX CO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 600001852 . This is a "RAILROAD MEDICARE-HARDIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 010017185 . This is a "RAILROAD MEDICARE-PULASKI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 600001836 . This is a "RAILROAD MEDICARE - UNION COUNTY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 600001851 . This is a "RAILROAD MEDICARE-JOHNSON" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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