Provider Demographics
NPI:1164666988
Name:MARSHALL BROWNING HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:MARSHALL BROWNING HOSPITAL ASSOCIATION
Other - Org Name:MARSHALL BROWNING HOSPITAL PHYSICIANS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-542-2146
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-0192
Mailing Address - Country:US
Mailing Address - Phone:618-542-2146
Mailing Address - Fax:618-542-5920
Practice Address - Street 1:900 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1230
Practice Address - Country:US
Practice Address - Phone:618-542-2146
Practice Address - Fax:618-542-5920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL BROWNING HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001388261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL244OtherBLUE CROSS
IL272980OtherHEALTHLINK
IL7315813OtherBLUE SHIELD
ILCF1574OtherPALMATO-GBA / RRMC-GROUP
IL807200OtherMEDICARE ID PART B
ILCF1574OtherPALMATO-GBA / RRMC-GROUP