Healthcare Provider Details

I. General information

NPI: 1528769825
Provider Name (Legal Business Name): MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N COUNTY ROAD 2050 E
CARTHAGE IL
62321-3551
US

IV. Provider business mailing address

PO BOX 160
CARTHAGE IL
62321-0160
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-6888
  • Fax: 217-357-6889
Mailing address:
  • Phone: 217-357-8500
  • Fax: 217-357-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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