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General NPI Number Information
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NPI Number | 1346305638
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 W JACKSON ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1474
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Country | US
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Telephone | 618-549-0721
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 W JOSEPHINE LN
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City | MARION
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State | IL
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Zip | 62959-1564
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Country | US
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Telephone | 618-993-6963
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. JEFFREY RICHARD FOX
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Credential | P.T.
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Telephone | 618-549-0721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number |
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License Number State | IL
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