Provider Demographics
NPI:1023169885
Name:SAINT ANTHONYS HEALTH CENTER HOSPITAL
Entity type:Organization
Organization Name:SAINT ANTHONYS HEALTH CENTER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE-PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-465-2571
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-0340
Mailing Address - Country:US
Mailing Address - Phone:618-465-2571
Mailing Address - Fax:618-463-5223
Practice Address - Street 1:915 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6434
Practice Address - Country:US
Practice Address - Phone:618-465-2571
Practice Address - Fax:618-463-5223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT ANTHONYS HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL002000362251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL141573Medicare ID - Type Unspecified