Healthcare Provider Details

I. General information

NPI: 1255241360
Provider Name (Legal Business Name): MASON DISTRICT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
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
HAVANA IL
62644-1243
US

V. Phone/Fax

Practice location:
  • Phone: 309-543-4431
  • Fax: 309-543-8113
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEREMIAH VANCE
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 309-543-4431