Organization
GHOLSON FUNERAL HOME LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J.B. GHOLSON (DIRECTOR)
(618) 643-2321
Entity
Organization
Contact information
Practice address
500 S WASHINGTON ST, MC LEANSBORO, IL 62859-1238
(618) 643-2321
(618) 643-2322
Mailing address
500 S WASHINGTON ST, MC LEANSBORO, IL 62859-1238
(618) 643-2321
(618) 643-2322
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
5172
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008470065
BLUE CROSS BLUE SHIELD IL
IL
01
—
590155125
RAILROAD MEDICARE
IL
Enumeration date
11/14/2006
Last updated
02/21/2012
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