Provider Demographics
NPI:1750457461
Name:CARLINVILLE AREA HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:CARLINVILLE AREA HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-854-3141
Mailing Address - Street 1:20733 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1499
Mailing Address - Country:US
Mailing Address - Phone:217-854-3141
Mailing Address - Fax:217-854-9958
Practice Address - Street 1:20733 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1499
Practice Address - Country:US
Practice Address - Phone:217-854-3141
Practice Address - Fax:217-854-9958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLE MACOUPIN HEALTHCARE SYSTEMS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000182282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid