Healthcare Provider Details

I. General information

NPI: 1760439715
Provider Name (Legal Business Name): SAINT ANTHONY'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 STATE ST
ALTON IL
62002-4319
US

IV. Provider business mailing address

2350 STATE ST
ALTON IL
62002-4319
US

V. Phone/Fax

Practice location:
  • Phone: 618-466-5632
  • Fax: 618-466-4642
Mailing address:
  • Phone: 618-466-5632
  • Fax: 618-466-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateIL

VIII. Authorized Official

Name: MIKE NELSON
Title or Position: CFO FINANCE
Credential:
Phone: 618-465-2571