1053481630 NPI number — ANDERSON HOSPITAL

Table of content: (NPI 1053481630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053481630 NPI number — ANDERSON HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON HOSPITAL
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:
6
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:
1053481630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6800 STATE ROUTE 162
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62062-8500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-288-5711
Provider Business Mailing Address Fax Number:
618-288-4088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 STATE ROUTE 162
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62062-8500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-288-5711
Provider Business Practice Location Address Fax Number:
618-288-4088
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARVEY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
618-288-5711

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  1706469 , 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: 208 . This is a "ALLIANCE CHOICE BC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 105770 . This is a "HEALTHLINK HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50-07001 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 198360 . This is a "HARMONY HEALTH PLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7630 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0078 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 011126901 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0069736 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 321071 . This is a "BLACK LUNG" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3309 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0920 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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