Provider Demographics
NPI:1588902183
Name:HAMILTON MEMORIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:HAMILTON MEMORIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-643-2361
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MC LEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859-0429
Mailing Address - Country:US
Mailing Address - Phone:618-643-2361
Mailing Address - Fax:618-643-2502
Practice Address - Street 1:1112 OAK ST
Practice Address - Street 2:STE 102
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1344
Practice Address - Country:US
Practice Address - Phone:618-382-5030
Practice Address - Fax:855-827-3536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMILTON MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-17
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148529Medicare Oscar/Certification