Basic Information
| Provider Information | |||||||||
| NPI: | 1689646523 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINCKNEYVILLE COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5383 STATE ROUTE 154 | ||||||||
| Address2: | |||||||||
| City: | PINCKNEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622743342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183572187 | ||||||||
| FaxNumber: | 6183578888 | ||||||||
| Practice Location | |||||||||
| Address1: | 5383 STATE ROUTE 154 | ||||||||
| Address2: | |||||||||
| City: | PINCKNEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622743342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183572187 | ||||||||
| FaxNumber: | 6183578888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2006 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | CARSON | ||||||||
| AuthorizedOfficialFirstName: | KARA | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6183572187 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 0001891 | IL | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 111948 | 01 | IL | HEALTHLINK PROVIDER ID | OTHER | CF1266 | 01 | IL | MEDICARE RAILROAD | OTHER | 277 | 01 | IL | BCBS HOSPITAL ID | OTHER | 003663 | 01 | IL | HEALTH ALLIANCE HOSPITAL | OTHER | 162116 | 01 | IL | UNITED HEALTHCARE ID | OTHER | 7315810 | 01 | IL | BCBS ER PHYS ID | OTHER |