1356382428 NPI number — HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Table of content: (NPI 1356382428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356382428 NPI number — HOOPESTON COMMUNITY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOOPESTON COMMUNITY MEMORIAL 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:
Provider Other Organization Name Type Code:
6
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:
1356382428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 E ORANGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOPESTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60942-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-383-6792
Provider Business Mailing Address Fax Number:
217-383-4752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 W. GARFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CISSNA PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60924-0502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-283-5531
Provider Business Practice Location Address Fax Number:
217-283-7981
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROCKUS
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
217-283-8540

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  0004200 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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