Provider Demographics
NPI:1689646523
Name:PINCKNEYVILLE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:PINCKNEYVILLE COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-357-2187
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-05
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001891282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL111948OtherHEALTHLINK PROVIDER ID
ILCF1266OtherMEDICARE RAILROAD
IL277OtherBCBS HOSPITAL ID
IL003663OtherHEALTH ALLIANCE HOSPITAL
IL162116OtherUNITED HEALTHCARE ID
IL7315810OtherBCBS ER PHYS ID
IL277OtherBCBS HOSPITAL ID
IL162116OtherUNITED HEALTHCARE ID
IL=========001Medicaid