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NPI Code Detail

MEDICARE: RICHLAND MEMORIAL HOSPITAL, INC

MEDICARE: RICHLAND MEMORIAL HOSPITAL, INC
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
1283Q00000XPsychiatric Hospital

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10267OTHERILBLUE CROSS

General Provider Information

NPI Number : 1528014834
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHLAND MEMORIAL HOSPITAL, INC
Provider Business Mailing Address
First Line : 800 E LOCUST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2553
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 E LOCUST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-2553
Country : US
Telephone Number : 618-395-7340
Fax Number :
Authorized Official
Title or Position : CEO
Name : HARRY BROCKUS
Credential :
Telephone Number : 217-283-8540
Provider Enumeration Date : 05/26/2006
Last Update Date : 05/09/2018

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