Provider Demographics
NPI:1255303798
Name:PINCKNEYVILLE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:PINCKNEYVILLE COMMUNITY HOSPITAL
Other - Org Name:LUKE MEMORIAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-357-2187
Mailing Address - Street 1:101 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-1034
Mailing Address - Country:US
Mailing Address - Phone:618-357-2187
Mailing Address - Fax:618-357-6740
Practice Address - Street 1:101 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1034
Practice Address - Country:US
Practice Address - Phone:618-357-5491
Practice Address - Fax:618-357-3903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINCKNEYVILLE COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054531OtherHEALTH ALLIANCE
IL2460775OtherUNITED HEALTHCARE ID
IL50255OtherBCBS PROVIDER ID
IL=========009Medicaid
IL50255OtherBCBS PROVIDER ID