Provider Demographics
NPI:1912490277
Name:MARSHALL BROWNING HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:MARSHALL BROWNING HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-542-1005
Mailing Address - Street 1:900 N. WASHINGTON
Mailing Address - Street 2:PO BOX 192
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-0192
Mailing Address - Country:US
Mailing Address - Phone:618-542-2146
Mailing Address - Fax:
Practice Address - Street 1:916 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1200
Practice Address - Country:US
Practice Address - Phone:618-790-7401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL BROWNING HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-12
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
IL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6283201Medicaid