Healthcare Provider Details

I. General information

NPI: 1063478782
Provider Name (Legal Business Name): MASON HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N PROMENADE ST
HAVANA IL
62644-1243
US

IV. Provider business mailing address

615 N PROMENADE ST P O BOX 530
HAVANA IL
62644-1015
US

V. Phone/Fax

Practice location:
  • Phone: 309-543-6600
  • Fax: 309-543-2089
Mailing address:
  • Phone: 309-543-6600
  • Fax: 309-543-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARY L LAYTON
Title or Position: DIRECTOR OF CLINIC OPERATIONS
Credential:
Phone: 309-543-8542