Healthcare Provider Details

I. General information

NPI: 1932355625
Provider Name (Legal Business Name): MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S ADAMS ST
CARTHAGE IL
62321-1600
US

IV. Provider business mailing address

PO BOX 160
CARTHAGE IL
62321-0160
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-3131
  • Fax: 217-357-6564
Mailing address:
  • Phone: 217-357-3131
  • Fax: 217-357-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1874988
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0001529
License Number StateIL

VIII. Authorized Official

Name: MS. ADA BAIR
Title or Position: CEO
Credential:
Phone: 217-357-6566