Provider Demographics
NPI:1538105523
Name:CRAWFORD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CRAWFORD HOSPITAL DISTRICT
Other - Org Name:CRAWFORD MEMORIAL HOSPITAL D/B/A CMH PALESTINE RURAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGEMENT OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-544-8600
Mailing Address - Street 1:1101 N ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1168
Mailing Address - Country:US
Mailing Address - Phone:618-544-8600
Mailing Address - Fax:618-546-2641
Practice Address - Street 1:209 E GRAND PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:IL
Practice Address - Zip Code:62451-1254
Practice Address - Country:US
Practice Address - Phone:618-544-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAWFORD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========009Medicaid
IL=========009Medicaid