Provider Demographics
NPI:1417303181
Name:MASSAC MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MASSAC MEMORIAL HOSPITAL
Other - Org Name:BHARAT PATEL, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-524-2176
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-0850
Mailing Address - Country:US
Mailing Address - Phone:618-524-2176
Mailing Address - Fax:
Practice Address - Street 1:1204 W 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-2482
Practice Address - Country:US
Practice Address - Phone:618-524-2182
Practice Address - Fax:618-524-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital