Provider Demographics
NPI:1669438750
Name:CRAWFORD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CRAWFORD HOSPITAL DISTRICT
Other - Org Name:CRAWFORD MEMORIAL HOSPITAL AND HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-546-2514
Mailing Address - Street 1:1000 N ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1167
Mailing Address - Country:US
Mailing Address - Phone:618-544-3131
Mailing Address - Fax:618-546-2647
Practice Address - Street 1:1000 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1167
Practice Address - Country:US
Practice Address - Phone:618-544-3131
Practice Address - Fax:618-546-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001189251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
14-7175Medicare ID - Type Unspecified