Provider Demographics
NPI:1629039706
Name:PINCKNEYVILLE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:PINCKNEYVILLE COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MACC, CPA, CHFP
Authorized Official - Phone:618-357-5902
Mailing Address - Street 1:5383 STATE ROUTE 154
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-3342
Mailing Address - Country:US
Mailing Address - Phone:618-357-2187
Mailing Address - Fax:618-357-8888
Practice Address - Street 1:5383 STATE ROUTE 154
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-3342
Practice Address - Country:US
Practice Address - Phone:618-357-2187
Practice Address - Fax:618-357-8888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINCKNEYVILLE COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL003663OtherHEALTH ALLIANCE HOSPITAL
IL111948OtherHEALTHLINK PROVIDER ID
IL162116OtherUNITED HEALTHCARE ID
IL111948OtherHEALTHLINK PROVIDER ID