1467492124 NPI number — RICHLAND MEMORIAL HOSPITAL, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467492124 NPI number — RICHLAND MEMORIAL HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHLAND MEMORIAL 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:
Provider Other Organization Name Type Code:
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:
1467492124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 E LOCUST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62450-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62450-2553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-395-7340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROCKUS
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
618-395-7340

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 037381600 . This is a "BLACK LUNG" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 135995 . This is a "USA HEALTH & WELFARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 376016979 . This is a "V A" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 368243500 . This is a "DEPT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0267 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "METRA HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: HEALTHLINK . This is a "106919" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: L041054 . This is a "TRICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 003572 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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