Provider Demographics
NPI:1265467195
Name:SALEM TOWNSHIP HOSPITAL
Entity Type:Organization
Organization Name:SALEM TOWNSHIP HOSPITAL
Other - Org Name:STH RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA/MBA/MHA
Authorized Official - Phone:618-548-3194
Mailing Address - Street 1:1201 RICKER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881
Mailing Address - Country:US
Mailing Address - Phone:618-548-3194
Mailing Address - Fax:618-548-6831
Practice Address - Street 1:1201 RICKER DRIVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881
Practice Address - Country:US
Practice Address - Phone:618-548-3194
Practice Address - Fax:618-740-0122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALEM TOWNSHIP HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002089261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143413Medicare ID - Type UnspecifiedRHC SERVICES