1407463649 NPI number — MORRISON COMMUNITY HOSPITAL DISTRICT

Table of content: (NPI 1407463649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407463649 NPI number — MORRISON COMMUNITY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRISON COMMUNITY 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:
MORRISON COMMUNITY HOSPITAL SPECIALIST CLINIC
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:
1407463649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 N JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61270-3042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-772-4003
Provider Business Mailing Address Fax Number:
815-772-5599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4622 PROGRESS DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52807-3426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-772-5505
Provider Business Practice Location Address Fax Number:
815-772-5591
Provider Enumeration Date:
09/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PFISTER
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
815-772-5530

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1811191299 . This is a "BCBSIL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1619957180 . This is a "PHYSICIAN NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1982675542 . This is a "PHYSICIAN NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1174644629 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831708288 . This is a "NURSE PRACTITIONER NPI" identifier . This identifiers is of the category "OTHER".




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