Organization
PROTESTANT MEMORIAL MEDICAL CENTER,INC
Active
Other names
MEMORIAL HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE H LANIUS (VICE PRESIDENT, FINANCE)
(618) 257-5648
Entity
Organization
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 233-7750
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 233-7750
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0001461
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008219585
BLUE SHIELD
IL
Enumeration date
10/17/2006
Last updated
02/19/2013
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