Healthcare Provider Details

I. General information

NPI: 1346212883
Provider Name (Legal Business Name): PINCKNEYVILLE COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N WALNUT ST
PINCKNEYVILLE IL
62274-1034
US

IV. Provider business mailing address

101 N WALNUT ST
PINCKNEYVILLE IL
62274-1034
US

V. Phone/Fax

Practice location:
  • Phone: 618-357-2187
  • Fax: 618-357-6740
Mailing address:
  • Phone: 618-357-2187
  • Fax: 618-357-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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