Provider Demographics
NPI:1184671463
Name:WASHINGTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WASHINGTON COUNTY HOSPITAL DISTRICT
Other - Org Name:WASHINGTON COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-327-8236
Mailing Address - Street 1:705 S GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1534
Mailing Address - Country:US
Mailing Address - Phone:618-327-8236
Mailing Address - Fax:618-327-2209
Practice Address - Street 1:705 S GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1534
Practice Address - Country:US
Practice Address - Phone:618-327-2225
Practice Address - Fax:618-327-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========401Medicaid
IL143472Medicare ID - Type Unspecified