Healthcare Provider Details

I. General information

NPI: 1790769073
Provider Name (Legal Business Name): CRAWFORD HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1366 EAST 1050TH AVE
OBLONG IL
62449-1426
US

IV. Provider business mailing address

1000 N ALLEN ST
ROBINSON IL
62454-1114
US

V. Phone/Fax

Practice location:
  • Phone: 618-592-3119
  • Fax: 618-546-2648
Mailing address:
  • Phone: 618-592-3119
  • Fax: 618-546-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRIS BAUTISTA
Title or Position: PRACTICE MANAGEMENT OFFICER
Credential:
Phone: 618-546-2460