1033397138 NPI number — SPRINGFIELD HOSPITAL, INC.

Table of content: JOSEPH LAKE CRNA (NPI 1962402511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033397138 NPI number — SPRINGFIELD HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGFIELD HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LINCOLN PRAIRIE BEHAVIORAL HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033397138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5230 S. 6TH STREET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-585-1180
Provider Business Mailing Address Fax Number:
217-585-4747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5230 S 6TH STREET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62703-5128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-585-1180
Provider Business Practice Location Address Fax Number:
217-585-4747
Provider Enumeration Date:
01/31/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP CFO
Authorized Official Telephone Number:
610-768-3300

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)