MEDICARE: PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	0004853	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427000884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK

Provider Business Mailing Address
First Line	:	812 NORTH LOGAN AVE
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3752
Country	:	US
Telephone Number	:	217-443-5000
Fax Number	:	217-477-2761

Provider Business Practice Location Address
First Line	:	812 NORTH LOGAN AVE
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3752
Country	:	US
Telephone Number	:	217-443-5000
Fax Number	:	217-477-2761

Authorized Official
Title or Position	:	AMITA CFO
Name	:	RICHARD DOUGLAS CARTER
Credential	:
Telephone Number	:	224-373-2350

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	12/29/2021

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Directions to “PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK ” Practice Location

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