1629118609 NPI number — JAVON BEA HOSPITAL

Table of content: (NPI 1629118609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629118609 NPI number — JAVON BEA HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAVON BEA 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:
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:
1629118609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 N ROCKTON AVE
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:
61103-3655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-971-5000
Provider Business Mailing Address Fax Number:
815-968-0170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8201 E RIVERSIDE BLVD
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:
61114-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-971-7000
Provider Business Practice Location Address Fax Number:
815-968-4795
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/CFO
Authorized Official Telephone Number:
608-756-6000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0002048 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 090109100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 720850200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100034510A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11002400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 372 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1400239 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0927533 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1121340 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP30083 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108771105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140239 . This is a "IL MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 011307204 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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