Healthcare Provider Details

I. General information

NPI: 1689646523
Provider Name (Legal Business Name): PINCKNEYVILLE COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5383 STATE ROUTE 154
PINCKNEYVILLE IL
62274-3342
US

IV. Provider business mailing address

5383 STATE ROUTE 154
PINCKNEYVILLE IL
62274-3342
US

V. Phone/Fax

Practice location:
  • Phone: 618-357-2187
  • Fax: 618-357-8888
Mailing address:
  • Phone: 618-357-2187
  • Fax: 618-357-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0001891
License Number StateIL

VIII. Authorized Official

Name: MRS. KARA JO CARSON
Title or Position: CFO
Credential:
Phone: 618-357-2187