Healthcare Provider Details

I. General information

NPI: 1710943907
Provider Name (Legal Business Name): HAMILTON MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S WASHINGTON ST
MC LEANSBORO IL
62859-1147
US

IV. Provider business mailing address

611 S MARSHALL AVE PO BOX 429
MC LEANSBORO IL
62859-1213
US

V. Phone/Fax

Practice location:
  • Phone: 618-643-4415
  • Fax: 618-643-4508
Mailing address:
  • Phone: 618-643-4415
  • Fax: 618-643-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1001486
License Number StateIL

VIII. Authorized Official

Name: MR. JUSTIN EPPERSON
Title or Position: CFO
Credential:
Phone: 618-643-2361