Basic Information
Provider Information
NPI: 1750457461
EntityType: 2
ReplacementNPI:  
OrganizationName: CARLINVILLE AREA HOSPITAL ASSOCIATION
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CARLINVILLE AREA HOSPITAL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 MORGAN ST
Address2:  
City: CARLINVILLE
State: IL
PostalCode: 626261448
CountryCode: US
TelephoneNumber: 2178543141
FaxNumber: 2178549958
Practice Location
Address1: 1001 MORGAN ST
Address2:  
City: CARLINVILLE
State: IL
PostalCode: 626261448
CountryCode: US
TelephoneNumber: 2178543141
FaxNumber: 2178549958
Other Information
ProviderEnumerationDate: 11/27/2006
LastUpdateDate: 06/04/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LISS
AuthorizedOfficialFirstName: BARRY
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: CONTROLLER
AuthorizedOfficialTelephone: 2178543141
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: MIDDLE MACOUPIN HEALTHCARE SYSTEMS, INC
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X0000182ILY HospitalsGeneral Acute Care Hospital 

No ID Information.


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