1073979308 NPI number — SCHUYLER COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1073979308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073979308 NPI number — SCHUYLER COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHUYLER COUNTY HOSPITAL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RUSHVILLE FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073979308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
238 S CONGRESS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSHVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62681-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-322-4321
Provider Business Mailing Address Fax Number:
217-322-6459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 S CONGRESS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSHVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62681-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-322-3345
Provider Business Practice Location Address Fax Number:
217-322-6878
Provider Enumeration Date:
12/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GADBERRY
Authorized Official First Name:
TAMRA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
217-322-5296

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14D1095968 . This is a "CLINICAL LABORATORY IMPROVEMENT AMENDMENTS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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