Active NPI
Salem Township Hospital
- Family Medicine Physician
- Salem, IL
National Provider Identifier
1629433784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- SALEM TOWNSHIP HOSPITAL
- Doing business as
- STH Family Health Care Center
- Practice address
- 1321 W Whittaker St
Salem, IL 62881-2013 - Phone
- (618) 548-0200
- Fax
- (618) 548-0924
- NPI assigned
- Dec 16, 2015
- Organization subpart
- Yes
- Parent organization
- SALEM TOWNSHIP HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kendra K Taylor, MSN
- Title
- Chief Executive Officer
- Phone
- (618) 548-3194
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Family Nurse Practitioner | 363LF0000X |
Addresses
Primary practice location
1321 W Whittaker St
Salem, IL 62881-2013
Mailing address
1201 Ricker Rd
Salem, IL 62881-4263
Phone (618) 548-3194
Other names 1
- STH Family Health Care Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031126000688 | IL | Part B Supplier - Clinic/Group Practice | 0840195277 |
Receives reassigned benefits from 42 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Salem, IL |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Clinical Cardiac Electrophysiology Physician
- Salem, IL
- NPI 1518024637
O20031126000688
-
- Certified Registered Nurse Anesthetist
- Salem, IL
- NPI 1770649931
O20031126000688
National Provider Directory
National Provider Directory- Part of
- Public Hosp of the Town
Locations
1321 W Whittaker St
Salem, IL 62881
Phone (618) 548-0200
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Mount Vernon, IL
- NPI 1417573734
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450224000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1580169600000",
"number": "1629433784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 RICKER RD",
"city": "SALEM",
"state": "IL",
"postal_code": "628814263",
"telephone_number": "618-548-3194",
"fax_number": "618-548-0924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1321 W WHITTAKER ST",
"city": "SALEM",
"state": "IL",
"postal_code": "628812013",
"telephone_number": "618-548-0200",
"fax_number": "618-548-0924"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SALEM TOWNSHIP HOSPITAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SALEM TOWNSHIP HOSPITAL",
"enumeration_date": "2015-12-16",
"last_updated": "2020-01-28",
"certification_date": "2020-01-28",
"status": "A",
"authorized_official_last_name": "TAYLOR",
"authorized_official_first_name": "KENDRA",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "618-548-3194",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "MSN"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "STH Family Health Care Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "STH Family Health Care Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Salem, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.