Healthcare Provider Details

I. General information

NPI: 1609837665
Provider Name (Legal Business Name): HAMILTON MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S MARSHALL AVENUE
MCLEANSBORO IL
62859
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: 618-643-2361
  • Fax: 618-643-2875
Mailing address:
  • Phone: 618-643-2361
  • Fax: 618-643-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number000085
License Number StateIL

VIII. Authorized Official

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