Healthcare Provider Details

I. General information

NPI: 1588614002
Provider Name (Legal Business Name): MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N COUNTY RD 2050
CARTHAGE IL
62321-0160
US

IV. Provider business mailing address

PO BOX 160
CARTHAGE IL
62321-0160
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-2173
  • Fax: 217-357-3610
Mailing address:
  • Phone: 217-357-2173
  • Fax: 217-357-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: TERESA SMITH
Title or Position: CFO
Credential:
Phone: 217-357-8573