1982428298 NPI number — MCDONOUGH COUNTY HOSPITAL DISTRICT

Table of content: MS. JANET LEA BOWDEN M.A. (NPI 1578932067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982428298 NPI number — MCDONOUGH COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCDONOUGH COUNTY 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:
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:
1982428298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
533 E GRANT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACOMB
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-575-4679
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
533 E GRANT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACOMB
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-575-4679
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2024

Additional Information

Authorized Official

Authorized Official Last Name:
DZIUBA
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
CHRISTINA
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
309-575-4679

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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