MASSAC MEMORIAL HOSPITAL (NPI# 1790788578) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790788578 |
| Entity Type | Organization |
| Organization Name | MASSAC MEMORIAL HOSPITAL |
| Other Organization Name | MASSAC MEMORIAL HOSPITAL |
| Practice Address |
28 Chick St Metropolis IL 62960-2467 |
| Mailing Address |
Po Box 850 28 Chick St Metropolis IL 62960-0850 |
| Practice Telephone | 6185242176 |
| Practice Fax Number | 6185244131 |
| Mailing Telephone | 6185242176 |
| Mailing Fax Number | 6185244131 |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2018-11-20 |
| Authorized Official Name | MRS. LYNN GOINES (CFO) |
| Authorized Official Telephone | 6185242176 |
| Is Organization Subpart | Y |
| Parent Organization Name | MASSAC COUNTY HOSPITAL DISTRICT |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
0001420 | IL | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 13019 | 05 | |
| TN | BLUE CROSS | 3582 | 01 |
| KY | 01330034 | 05 | |
| TN | 0140042 | 05 | |
| 000795 | HEALTH ALLIANCE | 01 | |
| IL | BLUE SHIELD ILLINOIS | 6415006 | 01 |
| ENERGY EMPLOYEES OCCUP IL | 037520699 | 01 | |
| HEALTHLINK | 111575 | 01 | |
| IL | BLUE CROSS ILLINOIS | 317 | 01 |
| Other Name | Type Code |
|---|---|
| Massac Memorial Hospital | Doing Business As Name - Organization |
| Massac Memorial Hospital | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740355809 | Massac Memorial Hospital | Clinic/Center | 1204 W 10th St, Metropolis, IL 62960-0790 | 2006-11-22 |
| 1356968275 | Massac Memorial Hospital | Clinic/Center | 510 W 10th St, Metropolis, IL 62960-1562 | 2020-06-26 |
| 1417303181 | Massac Memorial Hospital | Clinic/Center | 28 Chick St Ste 100, Metropolis, IL 62960-2467 | 2016-05-11 |
| 1831226901 | Massac Memorial Hospital | Medicare Defined Swing Bed Unit | 28 Chick St, Metropolis, IL 62960-2467 | 2007-02-27 |
| 1801941968 | Massac Memorial Hospital | Ambulance | 28 Chick St, Metropolis, IL 62960-2467 | 2007-01-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MASSAC MEMORIAL HOSPITAL | 28 Chick St, Metropolis, IL 62960-2467 |
| Street Address |
28 CHICK ST |
| City | METROPOLIS |
| State | IL |
| Zip Code | 62960-2467 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235772328 | Kincaid King Physician Services, P.C. | Physician Assistant | 28 Chick St, Metropolis, IL 62960-2467 | 2019-10-22 |
| 1598253361 | Kelly Sue Clark | Registered Nurse | 28 Chick St, Metropolis, IL 62960-2467 | 2018-04-27 |
| 1104283035 | Massac Ems | Ambulance | 28 Chick St, Metropolis, IL 62960-2467 | 2016-01-22 |
| 1801159835 | Jennifer Shoemate | Speech-Language Pathologist | 28 Chick St, Metropolis, IL 62960-2467 | 2012-06-25 |
| 1952663254 | Lori Miller | Physical Therapist | 28 Chick St, Metropolis, IL 62960-2467 | 2012-06-12 |
| 1942531835 | Michael J. & Beverly Hicks | Audiologist | 28 Chick St, Metropolis, IL 62960-2467 | 2010-01-17 |
| 1861633380 | Illinois Emergency Physicians LLP | Emergency Medicine | 28 Chick St, Metropolis, IL 62960-2467 | 2009-03-12 |
| 1780851428 | Eileen Patrice Laurence | Emergency Medicine | 28 Chick St, Metropolis, IL 62960-2467 | 2008-05-12 |
| 1417142449 | Michael Joe Hicks | Audiologist | 28 Chick St, Metropolis, IL 62960-2467 | 2007-09-12 |
| 1831226901 | Massac Memorial Hospital | Medicare Defined Swing Bed Unit | 28 Chick St, Metropolis, IL 62960-2467 | 2007-02-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972069078 | Amber Nicole Garcia | Social Worker | 205 W 5th Street, Metropolis, IL 62960 | 2019-02-13 |
| 1407251622 | Massac County Surgery Center LLC | Clinic/Center | 1811 E 5th St, Metropolis, IL 62960 | 2014-10-30 |
| 1750535761 | Robert Hays Bryan | Dentist | 805 Market St., Metropolis, IL 62960 | 2008-11-05 |
| 1518144682 | Rebecca Louise Mcquage | Counselor | 206 West 5th St, Metropolis, IL 62960 | 2008-01-30 |
| 1154640902 | Syed S Kazmi | Family Medicine | 12 Hospital Drive, Metropolis, IL 62960 | 2007-04-20 |
| 1083736680 | Bharat K Patel Sc | Internal Medicine | 12 Hospital Dr., Memorial Heights, Metropolis, IL 62960 | 2007-04-04 |
| 1467594747 | Peggy Sue Legereit | Speech-Language Pathologist | 3037 Lakeview Dr, Metropolis, IL 62960 | 2007-02-13 |
| 1821150475 | Ruth E Johnson | Counselor | 206 West 5th, Metropolis, IL 62960 | 2006-12-13 |
| 1720140379 | James Allen Haley | Counselor | 206 West 5th Street, Metropolis, IL 62960 | 2006-12-13 |
| 1659432185 | Gary T Brush | Optometrist | 1801 E 5th Street, Metropolis, IL 62960 | 2006-12-12 |
| Find all providers in zip 62960 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144846353 | Express Care, LLC | General Acute Care Hospital | 11 E Adams St Ste 1100, Chicago, IL 60603-6315 | 2020-06-23 |
| 1508152745 | Medical Connections | General Acute Care Hospital | 25749 Sunnymere Dr, Plainfield, IL 60585-1290 | 2011-06-27 |
| 1205127529 | Hammond Henry Hospital | General Acute Care Hospital | 1604 Cleveland Rd, Colona, IL 61241-8970 | 2011-04-20 |
| 1578885182 | Hillsboro Area Hospital | General Acute Care Hospital | 120 W Saint John St, Ste 2, Litchfield, IL 62056-2169 | 2010-02-23 |
| 1174787394 | Nenita P Cudiamat | General Acute Care Hospital | 668 Warwick Dr, Carol Stream, IL 60188-4332 | 2008-07-16 |
| 1740479047 | Benjamin David Tyrrell | General Acute Care Hospital | 1580 Sherman Ave, Ph04, Evanston, IL 60201-4465 | 2007-10-23 |
| 1881801330 | Natalie L Hughes | General Acute Care Hospital | 14293 Cr 3900 E, San Jose, IL 62682 | 2007-05-16 |
| 1023138864 | Morrison Community Hospital | General Acute Care Hospital | 333 Chicago Ave, Savanna, IL 61074-1964 | 2007-03-29 |
| 1720131667 | A. Koranteng Medical Ltd | General Acute Care Hospital | 419 Ridgemoor Dr, Willowbrook, IL 60527-5418 | 2007-01-22 |
| 1932275641 | Carlinville Area Hospital Association | General Acute Care Hospital | 1001 Morgan St, Carlinville, IL 62626-1448 | 2006-11-27 |
| Find all providers with the same taxonomy | ||||
| City | METROPOLIS |
| Zip Code | 62960 |
Please comment or provide details below to improve the information on MASSAC MEMORIAL HOSPITAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.