Healthcare Provider Details

I. General information

NPI: 1730304361
Provider Name (Legal Business Name): ABRAHAM LINCOLN MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STAHLHUT DR
LINCOLN IL
62656-5066
US

IV. Provider business mailing address

200 STAHLHUT DR
LINCOLN IL
62656-5066
US

V. Phone/Fax

Practice location:
  • Phone: 217-732-2161
  • Fax: 217-735-3526
Mailing address:
  • Phone: 217-605-5611
  • Fax: 217-735-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000018
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. HEIDI MALTIMORE
Title or Position: PATIENT ACCOUNT MANAGER
Credential:
Phone: 217-605-5611