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General NPI Number Information
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NPI Number | 1073858262
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 1454 N COUNTY ROAD 2050
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City | CARTHAGE
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State | IL
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Zip | 62321-3551
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Country | US
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Telephone | 217-357-8500
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Fax | 217-357-8564
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | CARTHAGE
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State | IL
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Zip | 62321-0160
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Country | US
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Telephone | 217-357-8500
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Fax | 217-357-8564
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Authorized Official
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Title or Position | CEO
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Name | MRS. ADA BAIR
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Credential |
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Telephone | 217-357-8566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 0005611
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License Number State | IL
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