Healthcare Provider Details

I. General information

NPI: 1902340748
Provider Name (Legal Business Name): MASON HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S EAST AVE
MANITO IL
61546
US

IV. Provider business mailing address

PO BOX 530
HAVANA IL
62644-0530
US

V. Phone/Fax

Practice location:
  • Phone: 309-968-5311
  • Fax:
Mailing address:
  • Phone: 309-543-6600
  • Fax: 309-543-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY L LAYTON
Title or Position: DIRECTOR OF CLINIC OPERATIONS
Credential:
Phone: 309-543-6600