Healthcare Provider Details

I. General information

NPI: 1114582913
Provider Name (Legal Business Name): HAMMOND HENRY DIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W FRONT ST
ANNAWAN IL
61234-7756
US

IV. Provider business mailing address

600 N COLLEGE AVE
GENESEO IL
61254-1091
US

V. Phone/Fax

Practice location:
  • Phone: 309-935-4100
  • Fax:
Mailing address:
  • Phone: 309-944-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHONDA RICE
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 309-944-9122