Provider Demographics
NPI:1447288360
Name:COUNTY OF ALEXANDER ALEXANDER COUNTY COURT HOUSE
Entity type:Organization
Organization Name:COUNTY OF ALEXANDER ALEXANDER COUNTY COURT HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-776-5958
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:26711 STATE HIGHWAY 3
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:IL
Mailing Address - Zip Code:62969-0190
Mailing Address - Country:US
Mailing Address - Phone:618-776-5958
Mailing Address - Fax:618-776-5960
Practice Address - Street 1:26711 STATE HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:IL
Practice Address - Zip Code:62969-0190
Practice Address - Country:US
Practice Address - Phone:618-776-5958
Practice Address - Fax:618-776-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL690332980001Medicaid
IL69033298001Medicaid
IL69033298001Medicaid