# MEMORIAL HOSPITAL OF CARBONDALE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SIH
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1649589268
- **Legal business name:** SIH
- **Authorized official:** MRS. AMY MARIE SURBURG ANP-BC (NURSE PRACTITIONER, PRE-ANESTHESIA)
- **Authorized official phone:** (618) 549-0721

## Contact information

- **Practice address:** 405 W JACKSON ST, CARBONDALE, IL 62901-1462
- **Practice address phone:** (618) 549-0721
- **Practice address fax:** (618) 529-0431
- **Mailing address:** 405 W JACKSON ST, CARBONDALE, IL 62901-1462
- **Mailing address phone:** (618) 549-0721
- **Mailing address fax:** (618) 529-0431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 209008246 | IL | Yes |

## Other

- **Enumeration date:** 09/30/2010
- **Last updated:** 09/30/2010