# GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC
- **Other names:** Gateway Regional Medical Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1083685887
- **Legal business name:** GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC
- **Authorized official:** RANDY MICHAEL COOPER (SVP FINANCE OPERATIONS/AO)
- **Authorized official phone:** (615) 221-3840

## Contact information

- **Practice address:** 2100 MADISON AVE, GRANITE CITY, IL 62040-4701
- **Practice address phone:** (618) 798-3000
- **Practice address fax:** (618) 798-3724
- **Mailing address:** PO BOX 503706, SAINT LOUIS, MO 63150-3706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 273Y00000X | Rehabilitation Hospital Unit | 1010199 | IL | Yes |

## Other

- **Enumeration date:** 01/30/2006
- **Last updated:** 09/03/2020