Provider Demographics
NPI:1053853143
Name:TOUCHETTE REGIONAL HOSPITAL - TRANSPORTATION
Entity Type:Organization
Organization Name:TOUCHETTE REGIONAL HOSPITAL - TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:TESIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-332-5298
Mailing Address - Street 1:5900 BOND AVE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62207-2326
Mailing Address - Country:US
Mailing Address - Phone:618-332-3060
Mailing Address - Fax:618-332-5430
Practice Address - Street 1:5900 BOND AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62207-2326
Practice Address - Country:US
Practice Address - Phone:618-332-3060
Practice Address - Fax:618-332-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)