MEDICARE: SALEM TOWNSHIP HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NR1301X	Rural Acute Care Hospital	0002089	IL
2	282NC0060X	Critical Access Hospital	0002089	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102929	OTHER	IL	HEALTHLINK
2	5286399	OTHER	IL	UNITED HEALTHCARE
3	0183	OTHER	IL	BLUE CROSS HOSPITAL

General Provider Information

NPI Number	:	1295739548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM TOWNSHIP HOSPITAL

Provider Business Mailing Address
First Line	:	1201 RICKER DRIVE
Second Line	:
City	:	SALEM
State	:	IL
Zip	:	62881
Country	:	US
Telephone Number	:	618-548-3194
Fax Number	:	618-548-0924

Provider Business Practice Location Address
First Line	:	1201 RICKER DRIVE
Second Line	:
City	:	SALEM
State	:	IL
Zip	:	62881
Country	:	US
Telephone Number	:	618-548-3194
Fax Number	:	618-740-0122

Authorized Official
Title or Position	:	PRESIDENT/CEO/CFO
Name	:	MR. JAMES TIMPE
Credential	:
Telephone Number	:	618-548-3194

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	08/01/2024

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Directions to “SALEM TOWNSHIP HOSPITAL ” Practice Location

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