1417352527 NPI number — JERSEY COMMUNITY HOSPITAL

Table of content: (NPI 1417352527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417352527 NPI number — JERSEY COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERSEY COMMUNITY 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:
JCH MEDICAL GROUP-HARDIN
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:
1417352527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 MAPLE SUMMIT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62052-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-498-7518
Provider Business Mailing Address Fax Number:
618-498-3052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 MYRTLE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-576-9407
Provider Business Practice Location Address Fax Number:
618-576-2260
Provider Enumeration Date:
10/31/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
BETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
618-498-8350

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  0001156 , 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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