Healthcare Provider Details

I. General information

NPI: 1902849649
Provider Name (Legal Business Name): MASON HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N PROMENADE ST
HAVANA IL
62644-1015
US

IV. Provider business mailing address

615 N. PROMENADE PO BOX 530
HAVANA IL
62644-0530
US

V. Phone/Fax

Practice location:
  • Phone: 309-543-4431
  • Fax: 309-543-8528
Mailing address:
  • Phone: 309-543-4431
  • Fax: 309-543-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0001412
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT J STOLBA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 309-543-4431