Provider Demographics
NPI:1871513655
Name:COUNTY OF MCLEAN
Entity type:Organization
Organization Name:COUNTY OF MCLEAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-888-5471
Mailing Address - Street 1:200 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5048
Mailing Address - Country:US
Mailing Address - Phone:309-888-5533
Mailing Address - Fax:309-452-8479
Practice Address - Street 1:200 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5048
Practice Address - Country:US
Practice Address - Phone:309-888-5533
Practice Address - Fax:309-452-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service