Healthcare Provider Details

I. General information

NPI: 1992197230
Provider Name (Legal Business Name): ST JOSEPH MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S HOSPITAL DR
MURPHYSBORO IL
62966-3333
US

IV. Provider business mailing address

2 S HOSPITAL DR
MURPHYSBORO IL
62966-3333
US

V. Phone/Fax

Practice location:
  • Phone: 618-684-3156
  • Fax:
Mailing address:
  • Phone: 618-684-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number054017104
License Number StateIL

VIII. Authorized Official

Name: CLAUDIA DENISE CREWS
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 618-684-3156