Provider Demographics
NPI:1629433784
Name:SALEM TOWNSHIP HOSPITAL
Entity Type:Organization
Organization Name:SALEM TOWNSHIP HOSPITAL
Other - Org Name:STH FAMILY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:618-548-3194
Mailing Address - Street 1:1201 RICKER RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-4263
Mailing Address - Country:US
Mailing Address - Phone:618-548-3194
Mailing Address - Fax:618-548-0924
Practice Address - Street 1:1321 W WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2013
Practice Address - Country:US
Practice Address - Phone:618-548-0200
Practice Address - Fax:618-548-0924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALEM TOWNSHIP HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-16
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty