=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699011882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANKLIN HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2012
-----------------------------------------------------
Last Update Date | 12/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 W FRANKLIN ST
-----------------------------------------------------
City | SESSER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62884-1456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-625-5061
-----------------------------------------------------
Fax | 618-625-6738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 BAILEY LN
-----------------------------------------------------
City | BENTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62812-1969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-439-3161
-----------------------------------------------------
Fax | 618-435-2969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER/CLINIC MGR
-----------------------------------------------------
Name | MR. MICHAEL J. BUDNICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-439-3161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC0050X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital Clinic/Center
-----------------------------------------------------
License Number | 0005231
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------