Organization
GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC
Active
Other names
Gateway Regional Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
TARA PEEK RICHARDSON (VP OF PATIENT FINANCIAL SERVICES)
(615) 221-3672
Entity
Organization
Contact information
Practice address
2100 MADISON AVE, GRANITE CITY, IL 62040-4701
(618) 798-3000
(618) 798-3724
Mailing address
PO BOX 503706, ST. LOUIS, MO 63150-3706
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
0005223
IL
282N00000X
General Acute Care Hospital
Primary
0005223
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010779809
MO MCAID
MO
01
—
103244
HEALTHLINK PPO
—
01
—
10685
ALLIANCE
—
01
—
50040
BCBS
—
01
—
5020040
HARRINGTON
—
Enumeration date
01/30/2006
Last updated
05/07/2018
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