Organization
MEMORIAL HOSPITAL ASSOCIATION
Active
Parent organization
MEMORIAL HOSPITAL ASSOCIATION
Other names
Bowen Family Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEMORIAL HOSPITAL ASSOCIATION
Authorized official
ADA M BAIR (CEO)
(217) 357-8566
Entity
Organization
Contact information
Practice address
209 E 5TH STREET, BOWEN, IL 62316
(217) 842-5211
(217) 842-5202
Mailing address
PO BOX 105, BOWEN, IL 62316-0105
(217) 842-5211
(217) 842-5202
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
0001529
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3420307
BLUE SHIELD
IL
Enumeration date
05/12/2006
Last updated
04/05/2019
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