Healthcare Provider Details

I. General information

NPI: 1487013876
Provider Name (Legal Business Name): HAMILTON MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S WASHINGTON ST
MC LEANSBORO IL
62859-1139
US

IV. Provider business mailing address

PO BOX 429
MC LEANSBORO IL
62859-0429
US

V. Phone/Fax

Practice location:
  • Phone: 618-643-2835
  • Fax: 618-643-2891
Mailing address:
  • Phone: 618-643-2361
  • Fax: 618-643-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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