Healthcare Provider Details

I. General information

NPI: 1801172903
Provider Name (Legal Business Name): ALTON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR
ALTON IL
62002-6722
US

IV. Provider business mailing address

1 MEMORIAL DR
ALTON IL
62002-6722
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-7301
  • Fax:
Mailing address:
  • Phone: 618-463-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2009455
License Number StateIL

VIII. Authorized Official

Name: DAVID A BRAASCH
Title or Position: PRESIDENT
Credential:
Phone: 618-463-7301