Healthcare Provider Details

I. General information

NPI: 1629433784
Provider Name (Legal Business Name): SALEM TOWNSHIP HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 W WHITTAKER ST
SALEM IL
62881-2013
US

IV. Provider business mailing address

1201 RICKER RD
SALEM IL
62881-4263
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-0200
  • Fax: 618-548-0924
Mailing address:
  • Phone: 618-548-3194
  • Fax: 618-548-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KENDRA K TAYLOR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSN
Phone: 618-548-3194