Provider Demographics
NPI:1538165600
Name:HARDIN COUNTY GENERAL HOSPITAL
Entity type:Organization
Organization Name:HARDIN COUNTY GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-285-6634
Mailing Address - Street 1:PO BOX 2467
Mailing Address - Street 2:
Mailing Address - City:ROSICLARE
Mailing Address - State:IL
Mailing Address - Zip Code:62982-2467
Mailing Address - Country:US
Mailing Address - Phone:618-285-6634
Mailing Address - Fax:618-285-3564
Practice Address - Street 1:6 FERRELL ROAD
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982
Practice Address - Country:US
Practice Address - Phone:618-285-6634
Practice Address - Fax:618-285-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000901282N00000X, 282NR1301X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0247OtherIL BC PROVIDER NO
IL=========001Medicaid
IL=========004Medicaid
IL0247OtherIL BC PROVIDER NO
ILG78722Medicare UPIN
IL141328Medicare ID - Type UnspecifiedINPATIENT AND OUTPATIENT
IL=========004Medicaid
ILE98343Medicare UPIN