| Organization Name: | GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC |
| NPI Number: | 1417353087 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES PATRICK WRIGHT (SR. DIRECTOR) |
| Mailing Address: | 4273 S State Route 159 Glen Carbon |
| State: | IL US |
| Postal Code: | 620343224 |
| Phone Number: | 6182882297 |
| Fax Number: | |
| NPI Enumeration Date: | 11/10/2014 |
| NPI Last Update Date: | 11/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |