NPIMap

Organization Active NPI

Clay County Health Department

  • Public Health or Welfare Agency
  • Flora, IL
National Provider Identifier
1700035201
Registry record updated Sep 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
CLAY COUNTY HEALTH DEPARTMENT
Practice address
601 E 12TH St
Flora, IL 62839-2335
Phone
(618) 662-4406
Fax
(618) 662-2801
NPI assigned
Sep 9, 2008
Last updated
Sep 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeffrey A Workman
Title
Administrator
Phone
(618) 662-4406

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

601 E 12TH St
Flora, IL 62839-2335

Mailing address

601 E 12TH St
Flora, IL 62839-2335
Phone (618) 662-4406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090324000364 IL Part B Supplier - Mass Immunization (Roster Biller Only) 4082524301 Practice locations: Flora, IL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Clay County HLTH Department3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clay Home Health ServicesFlora, IL, CCN 147086 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Dec 29, 1966
Dec 18, 1967
Clay County Health Department HospiceFlora, IL, CCN 141611 Hospice 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2003

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1700035201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E 12TH ST",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628392335",
            "telephone_number": "618-662-4406",
            "fax_number": "618-662-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E 12TH ST",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628392335",
            "telephone_number": "618-662-4406",
            "fax_number": "618-662-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAY COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2008-09-09",
        "status": "A",
        "authorized_official_last_name": "WORKMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-662-4406",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flora, IL

Sources for this page

Verify at the official NPI Registry.