Provider Demographics
NPI:1427261635
Name:TAYLORVILLE MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:TAYLORVILLE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-824-3331
Mailing Address - Street 1:201 E PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1562
Practice Address - Country:US
Practice Address - Phone:217-824-3331
Practice Address - Fax:217-824-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========408Medicaid