Healthcare Provider Details

I. General information

NPI: 1265540488
Provider Name (Legal Business Name): ANNA HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N MAIN ST
ANNA IL
62906-1668
US

IV. Provider business mailing address

1573 MALLORY LN STE 200
BRENTWOOD TN
37027-2895
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4511
  • Fax: 618-833-8481
Mailing address:
  • Phone: 615-221-1400
  • Fax: 615-221-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0005421
License Number StateIL

VIII. Authorized Official

Name: RANDY MICHAEL COOPER
Title or Position: SVP FINANCE OP/AUTHORIZED OFFICIAL
Credential:
Phone: 615-221-3840