Healthcare Provider Details

I. General information

NPI: 1093715799
Provider Name (Legal Business Name): COUNTY OF MERCER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 NW 9TH AVE
ALEDO IL
61231-1258
US

IV. Provider business mailing address

409 NW 9TH AVE
ALEDO IL
61231-1258
US

V. Phone/Fax

Practice location:
  • Phone: 309-582-5301
  • Fax: 309-582-3744
Mailing address:
  • Phone: 309-582-5301
  • Fax: 309-582-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0003772
License Number StateIL

VIII. Authorized Official

Name: MR. TED ROGALSKI
Title or Position: CEO
Credential:
Phone: 309-582-5301