# MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Randolph Hospital District
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629469002
- **Authorized official:** MRS. MORGAN BENDORF (CFO)
- **Authorized official phone:** (618) 826-4581

## Contact information

- **Practice address:** 1900 STATE ST, CHESTER, IL 62233-1116
- **Practice address phone:** (618) 826-2388
- **Mailing address:** 1900 STATE ST, CHESTER, IL 62233-1116
- **Mailing address phone:** (618) 826-4581

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 036-051292 | IL | — |
| 207Q00000X | Family Medicine Physician | 036-052369 | IL | — |
| 207Q00000X | Family Medicine Physician | 036-087561 | IL | — |
| 207Q00000X | Family Medicine Physician | 036-130378 | IL | — |
| 208600000X | Surgery Physician | 036-046019 | IL | — |
| 208600000X | Surgery Physician | 036-127160 | IL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 282NC0060X | Critical Access Hospital | 0001495 | IL | — |
| 363A00000X | Physician Assistant | 085-003568 | IL | — |
| 363A00000X | Physician Assistant | 085-003575 | IL | — |
| 363L00000X | Nurse Practitioner | 209-009681 | IL | — |
| 367500000X | Certified Registered Nurse Anesthetist | 041-149926 | IL | — |
| 367500000X | Certified Registered Nurse Anesthetist | 209-009387 | IL | — |

## Other

- **Enumeration date:** 02/06/2015
- **Last updated:** 10/11/2024