Provider Demographics
NPI:1154329753
Name:ABRAHAM LINCOLN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ABRAHAM LINCOLN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHANLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-605-5611
Mailing Address - Street 1:200 STAHLHUT DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-5066
Mailing Address - Country:US
Mailing Address - Phone:217-732-2161
Mailing Address - Fax:217-735-3526
Practice Address - Street 1:200 STAHLHUT DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-5066
Practice Address - Country:US
Practice Address - Phone:217-732-2161
Practice Address - Fax:217-735-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005728282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL272OtherBLUE CROSS
IL272OtherBLUE CROSS
IL=========001Medicaid