Provider Demographics
NPI:1497318299
Name:ST. MARGARET'S HOSPITAL
Entity Type:Organization
Organization Name:ST. MARGARET'S HOSPITAL
Other - Org Name:ST. MARGARETS HEALTH GRANVILLE CLIN
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNTS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KNEEBONE
Authorized Official - Suffix:
Authorized Official - Credentials:DELEGATED OFFICIAL
Authorized Official - Phone:815-664-1477
Mailing Address - Street 1:221 W SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1907
Mailing Address - Country:US
Mailing Address - Phone:815-664-1477
Mailing Address - Fax:
Practice Address - Street 1:309 S MCCOY ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61326-9333
Practice Address - Country:US
Practice Address - Phone:815-339-6245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARGARET'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center