MEDICARE: THOMAS H. BOYD MEMORIAL HOSPITAL

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
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1912090960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS H. BOYD MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	712 COLLEGE ST
Second Line	:
City	:	GREENFIELD
State	:	IL
Zip	:	62044-1409
Country	:	US
Telephone Number	:	217-368-3051
Fax Number	:	217-368-2213

Provider Business Practice Location Address
First Line	:	712 COLLEGE ST
Second Line	:
City	:	GREENFIELD
State	:	IL
Zip	:	62044-1409
Country	:	US
Telephone Number	:	217-368-3051
Fax Number	:	217-368-2213

Authorized Official
Title or Position	:	CEO
Name	:	STACE HOLLAND
Credential	:
Telephone Number	:	217-942-6946

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/22/2024

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