Provider Demographics
NPI:1265493720
Name:CRAWFORD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CRAWFORD HOSPITAL DISTRICT
Other - Org Name:CRAWFORD MEMORIAL HOSPITAL AND HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-546-2514
Mailing Address - Street 1:1000 N ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1167
Mailing Address - Country:US
Mailing Address - Phone:618-544-3131
Mailing Address - Fax:618-546-2647
Practice Address - Street 1:1000 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1167
Practice Address - Country:US
Practice Address - Phone:618-544-3131
Practice Address - Fax:618-546-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000455282N00000X, 282NC0060X
IL14D0044790291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000342OtherBLUE CROSS
6251270OtherAETNA
IL1715002OtherBLUE SHIELD
107378OtherHEALTHLINK
107378OtherHEALTHLINK
6251270OtherAETNA
14-1343Medicare ID - Type Unspecified
IL=========001Medicaid