Provider Demographics
NPI:1508305418
Name:COMMUNITY HOSPITAL OF STAUNTON
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL OF STAUNTON
Other - Org Name:COMMUNITY CLINIC OF STAUNTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-542-1089
Mailing Address - Street 1:325 N CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1421
Mailing Address - Country:US
Mailing Address - Phone:618-635-2221
Mailing Address - Fax:
Practice Address - Street 1:325 N CALDWELL ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1421
Practice Address - Country:US
Practice Address - Phone:618-635-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital