Healthcare Provider Details

I. General information

NPI: 1144313180
Provider Name (Legal Business Name): THOMAS H. BOYD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W LORTON ST
ROODHOUSE IL
62082-1569
US

IV. Provider business mailing address

132 W LORTON ST
ROODHOUSE IL
62082-1569
US

V. Phone/Fax

Practice location:
  • Phone: 217-589-4629
  • Fax: 217-589-4070
Mailing address:
  • Phone: 217-589-4629
  • Fax: 217-589-4070

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: STACE HOLLAND
Title or Position: CEO
Credential:
Phone: 217-942-6946