Provider Demographics
NPI:1144313180
Name:THOMAS H. BOYD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:THOMAS H. BOYD MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-942-6946
Mailing Address - Street 1:132 W LORTON ST
Mailing Address - Street 2:
Mailing Address - City:ROODHOUSE
Mailing Address - State:IL
Mailing Address - Zip Code:62082-1569
Mailing Address - Country:US
Mailing Address - Phone:217-589-4629
Mailing Address - Fax:217-589-4070
Practice Address - Street 1:132 W LORTON ST
Practice Address - Street 2:
Practice Address - City:ROODHOUSE
Practice Address - State:IL
Practice Address - Zip Code:62082-1569
Practice Address - Country:US
Practice Address - Phone:217-589-4629
Practice Address - Fax:217-589-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========008Medicaid
IL=========008Medicaid