1285720763 NPI number — SWEDISHAMERICAN HOSPITAL

Table of content: (NPI 1285720763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285720763 NPI number — SWEDISHAMERICAN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEDISHAMERICAN HOSPITAL
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:
SWEDISHAMERICAN INFUSION SERVICES
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:
1285720763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 CHARLES ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61108-1673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
779-696-7575
Provider Business Mailing Address Fax Number:
815-391-7578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 CHARLES ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61108-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
779-696-7575
Provider Business Practice Location Address Fax Number:
815-391-7578
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GANTZER
Authorized Official First Name:
ANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT OF PATIENT SERVICES
Authorized Official Telephone Number:
815-961-2030

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  054013179 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 203.000157 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10132144 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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