Provider Demographics
NPI:1427111046
Name:TOUCHETTE REGIONAL HOSPITAL, INC.
Entity type:Organization
Organization Name:TOUCHETTE REGIONAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-332-5400
Mailing Address - Street 1:5900 BOND AVE
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62207-2326
Mailing Address - Country:US
Mailing Address - Phone:618-332-5400
Mailing Address - Fax:618-332-5258
Practice Address - Street 1:5900 BOND AVE
Practice Address - Street 2:
Practice Address - City:CAHOKIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62207-2326
Practice Address - Country:US
Practice Address - Phone:618-332-5400
Practice Address - Fax:618-332-5258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0004523282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207503OtherHEALTHLINK
MO310OtherBLUE CROSS OF MISSOURI
IL038OtherBLUE CROSS OF ILLINOIS
MO010853307Medicaid
IN240711OtherHARMONY HEALTH PLAN
MO010853307Medicaid
IN240711OtherHARMONY HEALTH PLAN