Provider Demographics
NPI:1275609109
Name:CARLINVILLE AREA HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CARLINVILLE AREA HOSPITAL ASSOCIATION
Other - Org Name:CARLINVILLE AREA HOSPITAL ASSOCIATION - SWING BED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-854-3857
Mailing Address - Street 1:20733 NORTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626
Mailing Address - Country:US
Mailing Address - Phone:217-854-3141
Mailing Address - Fax:217-854-3744
Practice Address - Street 1:20733 NORTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626
Practice Address - Country:US
Practice Address - Phone:207-854-3141
Practice Address - Fax:217-854-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000182275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-Z347Medicare Oscar/Certification