1073584058 NPI number — MARION HOSPITAL CORPORATION

Table of content: (NPI 1073584058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073584058 NPI number — MARION HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION HOSPITAL CORPORATION
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:
HEARTLAND REGIONAL MEDICAL 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:
1073584058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60545
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63160-0001
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:
3333 W DEYOUNG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62959-5884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-998-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
SVP FINANCE OPERATIONS
Authorized Official Telephone Number:
615-221-3840

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0005288 , 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: 0068098 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 030050300 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003558 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0140184 . This is a "ACCESS MED PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0298 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 107233 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4908 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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