Healthcare Provider Details

I. General information

NPI: 1295739548
Provider Name (Legal Business Name): SALEM TOWNSHIP HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RICKER DRIVE
SALEM IL
62881
US

IV. Provider business mailing address

1201 RICKER DRIVE
SALEM IL
62881
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-3194
  • Fax: 618-740-0122
Mailing address:
  • Phone: 618-548-3194
  • Fax: 618-548-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0002089
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number0002089
License Number StateIL

VIII. Authorized Official

Name: MR. JAMES TIMPE
Title or Position: PRESIDENT/CEO/CFO
Credential:
Phone: 618-548-3194