1639595036 NPI number — SOUTHERN ILLINOIS HOSPITAL SERVICES

Table of content: (NPI 1639595036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639595036 NPI number — SOUTHERN ILLINOIS HOSPITAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN ILLINOIS HOSPITAL SERVICES
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:
ST. JOSEPH MEMORIAL HOSPITAL
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:
1639595036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 S HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHYSBORO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62966-3333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-684-2156
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 S HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURPHYSBORO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62966-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-684-2156
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HARTKE
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CORPORATE DIRECTOR OF PFS
Authorized Official Telephone Number:
618-457-5200

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  0004614 , 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: 141334 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 14Z334 . This is a "MEDICARE SWING BED PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 613930 . This is a "MEDICARE PART B PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com