Provider Demographics
NPI:1053577429
Name:COUNTY OF PEORIA
Entity type:Organization
Organization Name:COUNTY OF PEORIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNTY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-672-6056
Mailing Address - Street 1:324 MAIN ST
Mailing Address - Street 2:ROOM 501
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-2331
Mailing Address - Country:US
Mailing Address - Phone:309-677-6233
Mailing Address - Fax:309-495-4608
Practice Address - Street 1:2223 W HEADING AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-5139
Practice Address - Country:US
Practice Address - Phone:309-636-3600
Practice Address - Fax:309-636-3610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEORIA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-05
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1737473332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========804Medicaid
145961Medicare Oscar/Certification