1972706851 NPI number — SWEDISHAMERICAN HOSPITAL

Table of content: (NPI 1972706851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972706851 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:
LUNDHOLM ORTHOPEDICS A DEPARTMENT OF SWEDISHAMERICAN HOSPITAL
Provider Other Organization Name Type Code:
5
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:
1972706851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 78866
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53278-8866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
779-696-1900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANIELS
Authorized Official First Name:
DON
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
815-966-2084

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 081 . This is a "TRICARE SUFFIX #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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