Provider Demographics
NPI:1821099441
Name:MARSHALL BROWNING HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:MARSHALL BROWNING HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRYDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-542-2146
Mailing Address - Street 1:900 N WASHINGTON ST
Mailing Address - Street 2:P. O. BOX 192
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-1230
Mailing Address - Country:US
Mailing Address - Phone:618-542-2146
Mailing Address - Fax:618-542-4756
Practice Address - Street 1:900 N WASHINGTON ST
Practice Address - Street 2:BOX 192
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1230
Practice Address - Country:US
Practice Address - Phone:618-542-2146
Practice Address - Fax:618-542-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001388282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
188370OtherHEALTHLINK
IL7315813OtherBLUE SHIELD
005922OtherHEALTH ALLIANCE
IL244OtherBLUE CROSS
L026537OtherCHAMPUS
IL7315813OtherBLUE SHIELD
005922OtherHEALTH ALLIANCE
IL244OtherBLUE CROSS
IL14-Z331Medicare Oscar/Certification