1821099441 NPI number — MARSHALL BROWNING HOSPITAL ASSOCIATION

Table of content: (NPI 1821099441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821099441 NPI number — MARSHALL BROWNING HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARSHALL BROWNING HOSPITAL ASSOCIATION
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:
1821099441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 N WASHINGTON ST
Provider Second Line Business Mailing Address:
P. O. BOX 192
Provider Business Mailing Address City Name:
DU QUOIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62832-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-542-2146
Provider Business Mailing Address Fax Number:
618-542-4756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
BOX 192
Provider Business Practice Location Address City Name:
DU QUOIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62832-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-542-2146
Provider Business Practice Location Address Fax Number:
618-542-4756
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EAVES
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
618-542-2146

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  0001388 , 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: 244 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7315813 . This is a "BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 005922 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 188370 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: L026537 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".




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