Healthcare Provider Details

I. General information

NPI: 1790788578
Provider Name (Legal Business Name): MASSAC MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CHICK ST
METROPOLIS IL
62960-2467
US

IV. Provider business mailing address

PO BOX 850 28 CHICK ST
METROPOLIS IL
62960-0850
US

V. Phone/Fax

Practice location:
  • Phone: 618-524-2176
  • Fax: 618-524-4131
Mailing address:
  • Phone: 618-524-2176
  • Fax: 618-524-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0001420
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN GOINES
Title or Position: CFO
Credential:
Phone: 618-524-2176