Healthcare Provider Details

I. General information

NPI: 1861757361
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF CHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 STATE ST
CHESTER IL
62233-1116
US

IV. Provider business mailing address

1900 STATE ST
CHESTER IL
62233-1116
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-4581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070.018968
License Number StateIL

VIII. Authorized Official

Name: STEVE HAYES
Title or Position: ADMINISTRATOR
Credential:
Phone: 618-826-4581