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Organization Active NPI

Alton Memorial Hospital

Doing business as Family Care Pharmacy at Alton Memorial Hospital

  • Community/Retail Pharmacy
  • Alton, IL
National Provider Identifier
1326154238
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054011644 Issued in IL
Legal business name
ALTON MEMORIAL HOSPITAL
Doing business as
Family Care Pharmacy at Alton Memorial Hospital
Practice address
1 Memorial Dr
Room G247
Alton, IL 62002-6722
Phone
(618) 463-7865
Fax
(618) 463-7884
NPI assigned
Aug 22, 2006
Last updated
Mar 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Braasch
Title
President
Phone
(618) 463-7301

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 054011644 IL Primary

Addresses

Primary practice location

1 Memorial Dr
Room G247
Alton, IL 62002-6722

Mailing address

1 Memorial Dr
Room G247
Alton, IL 62002-6722
Phone (618) 463-7865

Other identifiers 1

IdentifierTypeStateIssuer
2022352OtherPK

Other names 1

  • FAMILY CARE PHARMACY AT ALTON MEMORIAL HOSPITAL Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930044315 IL DME Supplier - Pharmacy 8628982840 Practice locations: Alton, IL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Alton Mem Hosp Echocard6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 Memorial Dr
Rm G247
Alton, IL 62002
Phone (314) 657-9001

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Alton Memorial Rehab & TherapyAlton, IL, CCN 145121 Skilled nursing facility Operational/Managerial Control Jan 1, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1326154238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEMORIAL DR",
            "address_2": "ROOM G247",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026722",
            "telephone_number": "618-463-7865",
            "fax_number": "618-463-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEMORIAL DR",
            "address_2": "ROOM G247",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026722",
            "telephone_number": "618-463-7865",
            "fax_number": "618-463-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "BRAASCH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-463-7301"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054011644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2022352",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1 Memorial Dr",
            "address_2": "ROOM G247",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "FAMILY CARE PHARMACY AT ALTON MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY CARE PHARMACY AT ALTON MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.