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
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 0000182 | IL | Y |   | Hospitals | General Acute Care Hospital |   |
No ID Information.