Provider Demographics
NPI:1306907910
Name:KENNETH HALL REGIONAL HOSPITAL
Entity type:Organization
Organization Name:KENNETH HALL REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-274-1900
Mailing Address - Street 1:129 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2917
Mailing Address - Country:US
Mailing Address - Phone:618-274-1900
Mailing Address - Fax:618-482-7009
Practice Address - Street 1:129 N 8TH ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2917
Practice Address - Country:US
Practice Address - Phone:618-274-1900
Practice Address - Fax:618-482-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002667282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0143OtherBLUE CROSS OF ILLINOIS
IL31264OtherGROUP HEALTH PLAN
IL115992OtherHEALTHLINK
IL240713OtherHARMONY HEALTH PLAN
IL31264OtherGROUP HEALTH PLAN
IL140066Medicare ID - Type Unspecified