1487795357 NPI number — FREEPORT REGIONAL HEALTH CARE FOUNDATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487795357 NPI number — FREEPORT REGIONAL HEALTH CARE FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREEPORT REGIONAL HEALTH CARE FOUNDATION
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:
FHN COMMUNITY HEALTHCARE CENTER
Provider Other Organization Name Type Code:
3
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:
1487795357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 W EXCHANGE ST
Provider Second Line Business Mailing Address:
PO BOX 268
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61032-4030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-599-7958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 W LINDEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61032-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-599-8414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO PRESIDENT
Authorized Official Telephone Number:
815-599-6000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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