Healthcare Provider Details

I. General information

NPI: 1609984319
Provider Name (Legal Business Name): ALTON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/09/2008
Certification Date:
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: 618-463-7311
  • Fax: 314-653-4153
Mailing address:
  • Phone: 618-463-7311
  • Fax: 314-653-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1706379
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN N KATSIANIS JR.
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 314-653-5062