1467492124 NPI number — RICHLAND MEMORIAL HOSPITAL, INC

Table of content: (NPI 1467492124)

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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