Provider Demographics
NPI:1295739548
Name:SALEM TOWNSHIP HOSPITAL
Entity type:Organization
Organization Name:SALEM TOWNSHIP HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-548-3194
Mailing Address - Street 1:1201 RICKER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881
Mailing Address - Country:US
Mailing Address - Phone:618-548-3194
Mailing Address - Fax:618-548-0924
Practice Address - Street 1:1201 RICKER DRIVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881
Practice Address - Country:US
Practice Address - Phone:618-548-3194
Practice Address - Fax:618-740-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002089282NR1301X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL102929OtherHEALTHLINK
IL5286399OtherUNITED HEALTHCARE
IL0183OtherBLUE CROSS HOSPITAL
IL0183OtherBLUE CROSS HOSPITAL
IL102929OtherHEALTHLINK
IL=========007Medicaid
IL=========407MedicaidFEE FOR SERVICE
IL=========407MedicaidFEE FOR SERVICE
IL=========407Medicaid
IL0183OtherBLUE CROSS HOSPITAL
IL102929OtherHEALTHLINK
IL799390Medicare UPIN
IL141345Medicare Oscar/Certification