Provider Demographics
NPI:1659321560
Name:WASHINGTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WASHINGTON COUNTY HOSPITAL DISTRICT
Other - Org Name:WASHINGTON COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-327-2201
Mailing Address - Street 1:705 S GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1534
Mailing Address - Country:US
Mailing Address - Phone:618-327-2201
Mailing Address - Fax:618-327-2209
Practice Address - Street 1:705 S GRAND ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1534
Practice Address - Country:US
Practice Address - Phone:618-327-2201
Practice Address - Fax:618-327-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002899282NC0060X
IL054-017103333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155496OtherPK
IL=========001Medicaid
2155496OtherPK