Basic Information
| Provider Information | |||||||||
| NPI: | 1265540488 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANNA HOSPITAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNION COUNTY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1573 MALLORY LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370272895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152211400 | ||||||||
| FaxNumber: | 6152211487 | ||||||||
| Practice Location | |||||||||
| Address1: | 517 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ANNA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629061668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188334511 | ||||||||
| FaxNumber: | 6188338481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COOPER | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP FINANCE OP/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6152213840 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 0005421 | IL | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 003882 | 01 | HEALTH ALLIANCE | OTHER | 114579 | 01 | HEALTHLINK | OTHER | 8111 | 01 | GHP | OTHER | 0228 | 01 | BCBS | OTHER | 3760144201 | 05 | IL | MEDICAID | 3760144201 | 01 | CHAMPUS | OTHER |