Provider Demographics
NPI:1508932096
Name:RICHLAND MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:RICHLAND MEMORIAL HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-283-8540
Mailing Address - Street 1:800 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2553
Mailing Address - Country:US
Mailing Address - Phone:618-395-7340
Mailing Address - Fax:
Practice Address - Street 1:800 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2553
Practice Address - Country:US
Practice Address - Phone:618-395-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL041056OtherTRICARE PRO FEE PROVIDER
IL283653OtherHEALTHLINK PRO FEE PROVID
IL08022315OtherBLUE SHIELD PROVIDER NUMB
IL283653OtherHEALTHLINK PRO FEE PROVID
ILL041056OtherTRICARE PRO FEE PROVIDER
IL823500Medicare ID - Type UnspecifiedMEDICARE PRO FEE