Provider Demographics
NPI:1750308631
Name:COMMUNITY HOSPITAL OF STAUNTON
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL OF STAUNTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-542-1089
Mailing Address - Street 1:400 N CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:IL
Mailing Address - Zip Code:62088-1423
Mailing Address - Country:US
Mailing Address - Phone:618-635-2200
Mailing Address - Fax:618-635-4244
Practice Address - Street 1:400 N CALDWELL ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:IL
Practice Address - Zip Code:62088-1423
Practice Address - Country:US
Practice Address - Phone:618-635-2200
Practice Address - Fax:618-635-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000414282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid