Provider Demographics
NPI:1346323615
Name:HARDIN COUNTY GENERAL HOSPITAL CLINIC
Entity Type:Organization
Organization Name:HARDIN COUNTY GENERAL HOSPITAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-285-6634
Mailing Address - Street 1:6 FERRELL ROAD
Mailing Address - Street 2:
Mailing Address - City:ROSICLARE
Mailing Address - State:IL
Mailing Address - Zip Code:62982
Mailing Address - Country:US
Mailing Address - Phone:618-285-2800
Mailing Address - Fax:618-285-2804
Practice Address - Street 1:6 FERRELL ROAD
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982
Practice Address - Country:US
Practice Address - Phone:618-285-2800
Practice Address - Fax:618-285-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000901261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0247OtherBLUE CROSS PROVIDER NO.
IL=========001Medicaid
IL=========004Medicaid
IL143479Medicare ID - Type UnspecifiedCLINIC
IL=========004Medicaid
IL=========001Medicaid
IL14Z328Medicare Oscar/Certification
ILG78722Medicare UPIN
IL141328Medicare ID - Type UnspecifiedINPATIENT AND OUTPATIENT
IL818810Medicare ID - Type UnspecifiedPROFESSIONAL