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NPI Code Detail

MEDICARE: GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC

MEDICARE: GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1273R00000XPsychiatric Hospital Unit0005223IL
2282N00000XGeneral Acute Care Hospital0005223IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1010779809OTHERMOMO MCAID
210685OTHERALLIANCE
310685OTHERBC MO
45020040OTHERHARRINGTON
5103244OTHERHEALTHLINK PPO
650040OTHERBCBS

General Provider Information

NPI Number : 1083685986
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC
Provider Business Mailing Address
First Line : PO BOX 503706
Second Line :
City : ST. LOUIS
State : MO
Zip : 63150-3706
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2100 MADISON AVE
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-4701
Country : US
Telephone Number : 618-798-3000
Fax Number : 618-798-3724
Authorized Official
Title or Position : VP OF PATIENT FINANCIAL SERVICES
Name : TARA PEEK RICHARDSON
Credential :
Telephone Number : 615-221-3672
Provider Enumeration Date : 01/30/2006
Last Update Date : 05/07/2018

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Directions to “GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC ” Practice Location

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