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NPI Code Detail

MEDICARE: KENNETH HALL REGIONAL HOSPITAL, INC.

MEDICARE: KENNETH HALL REGIONAL 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
1207RP1001XPulmonary Disease PhysicianIL
2207Y00000XOtolaryngology PhysicianIL
3208600000XSurgery PhysicianIL
4207R00000XInternal Medicine PhysicianIL

General Provider Information

NPI Number : 1568473510
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENNETH HALL REGIONAL HOSPITAL, INC.
Provider Business Mailing Address
First Line : 1836 LACKLAND HILL PKWY
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-3572
Country : US
Telephone Number : 314-872-1439
Fax Number : 314-810-1399
Provider Business Practice Location Address
First Line : 129 N 8TH ST
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62201-2917
Country : US
Telephone Number : 618-482-7044
Fax Number : 618-482-7018
Authorized Official
Title or Position : COO
Name : MR. MICHAEL MCMANUS
Credential :
Telephone Number : 618-332-5212
Provider Enumeration Date : 08/11/2006
Last Update Date : 12/10/2007

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