Provider Demographics
NPI:1730304361
Name:ABRAHAM LINCOLN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ABRAHAM LINCOLN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-605-5611
Mailing Address - Street 1:200 STAHLHUT DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-5066
Mailing Address - Country:US
Mailing Address - Phone:217-605-5611
Mailing Address - Fax:217-735-3526
Practice Address - Street 1:200 STAHLHUT DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-5066
Practice Address - Country:US
Practice Address - Phone:217-732-2161
Practice Address - Fax:217-735-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
IL0000018282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBLUE CROSS 054102720OtherPROFESSIONAL SERVICES
ILC61676OtherMEDICARE RAILROAD
ILBLUE CROSS 054102720OtherPROFESSIONAL SERVICES
ILC61676OtherMEDICARE RAILROAD