Basic Information
| Provider Information | |||||||||
| NPI: | 1770649931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALEM TOWNSHIP HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 RICKER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185483194 | ||||||||
| FaxNumber: | 6185486831 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 RICKER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185483194 | ||||||||
| FaxNumber: | 6185486831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | NAZARIAN | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO/CFO | ||||||||
| AuthorizedOfficialTelephone: | 6185483194 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0002089 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.