1538111638 NPI number — SCHUYLER COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1538111638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538111638 NPI number — SCHUYLER COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHUYLER COUNTY HOSPITAL DISTRICT
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:
BEARDSTOWN CLINIC II
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:
1538111638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8460 SAINT LUKES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEARDSTOWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62618-8385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-323-2707
Provider Business Mailing Address Fax Number:
217-323-2920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8460 ST LUKES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEARDSTOWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-323-2707
Provider Business Practice Location Address Fax Number:
217-323-2920
Provider Enumeration Date:
05/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PALO
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICIER
Authorized Official Telephone Number:
217-322-4321

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 371354458001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".