Healthcare Provider Details

I. General information

NPI: 1679327779
Provider Name (Legal Business Name): MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 BROADWAY ST
HAMILTON IL
62341-1436
US

IV. Provider business mailing address

PO BOX 160
CARTHAGE IL
62321-0160
US

V. Phone/Fax

Practice location:
  • Phone: 217-551-3100
  • Fax: 217-551-3024
Mailing address:
  • Phone: 217-357-8500
  • Fax: 217-357-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA SMITH
Title or Position: CFO
Credential:
Phone: 217-357-8500