Organization
RICHLAND MEMORIAL HOSPITAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARRY BROCKUS (CEO)
(618) 395-7340
Entity
Organization
Contact information
Practice address
800 E LOCUST ST, OLNEY, IL 62450-2553
(618) 395-7340
Mailing address
PO BOX 97, OLNEY, IL 62450-0097
(618) 395-7340
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036050750
IL
208600000X
Surgery Physician
036060342
IL
208800000X
Urology Physician
036119328
IL
363L00000X
Nurse Practitioner
209004125
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08022315
BLUE SHIELD
IL
Enumeration date
01/28/2008
Last updated
12/22/2020
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