Provider Demographics
NPI:1710181797
Name:MASON HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MASON HOSPITAL DISTRICT
Other - Org Name:MASON DISTRICT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STOLBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-543-8505
Mailing Address - Street 1:615 N PROMENADE ST
Mailing Address - Street 2:PO BOX 530
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-1243
Mailing Address - Country:US
Mailing Address - Phone:309-543-4431
Mailing Address - Fax:309-543-8528
Practice Address - Street 1:615 N PROMENADE ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1243
Practice Address - Country:US
Practice Address - Phone:309-543-4431
Practice Address - Fax:309-543-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-Z313Medicare Oscar/Certification