Healthcare Provider Details

I. General information

NPI: 1750308631
Provider Name (Legal Business Name): COMMUNITY HOSPITAL OF STAUNTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N CALDWELL ST
STAUNTON IL
62088-1423
US

IV. Provider business mailing address

400 N CALDWELL ST
STAUNTON IL
62088-1423
US

V. Phone/Fax

Practice location:
  • Phone: 618-635-2200
  • Fax: 618-635-4244
Mailing address:
  • Phone: 618-635-2200
  • Fax: 618-635-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0000414
License Number StateIL

VIII. Authorized Official

Name: LARRY SPOUR
Title or Position: PRESIDENT
Credential:
Phone: 618-542-1089