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MEMORIAL HOSPITAL NPI 1629469002


NPI Information

NPI: 1629469002
Provider Name: MEMORIAL HOSPITAL

Other Name: RANDOLPH HOSPITAL DISTRICT

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 14D0950846

Address:
2319 OLD PLANK ROAD
CHESTER, IL
ZIP 62233
Phone: (618) 826-2388
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MEMORIAL HOSPITAL is a rural health clinic center in Chester, IL. MEMORIAL HOSPITAL NPI is 1629469002. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Randolph Hospital District.

The provider's business location address is:

2319 OLD PLANK ROAD
CHESTER, IL
ZIP 62233-116
Phone: (618) 826-2388

The provider's authorized official is Gail Miesner .
The authorized official title is Cfo and has the following contact phone number (618) 826-4581.

The CLIA number assigned to this NPI record is 14D0950846 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/6/2015 and was last updated on 6/9/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine036-051292ILLINOISNo
2207Q00000XFamily Medicine036-052369ILLINOISNo
3207Q00000XFamily Medicine036-130378ILLINOISNo
4207Q00000XFamily Medicine036-087561ILLINOISNo
5208600000XSurgery036-127160ILLINOISNo
6208600000XSurgery036-046019ILLINOISNo
7282NC0060XGeneral Acute Care HospitalCritical Access0001495ILLINOISNo
8363A00000XPhysician Assistant085-003568ILLINOISNo
9363A00000XPhysician Assistant085-003575ILLINOISNo
10363L00000XNurse Practitioner209-009681ILLINOISNo
11367500000XNurse Anesthetist, Certified Registered041-149926ILLINOISNo
12367500000XNurse Anesthetist, Certified Registered209-009387ILLINOISNo
13261QR1300XClinic/CenterRural HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1812110MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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