Healthcare Provider Details

I. General information

NPI: 1326880386
Provider Name (Legal Business Name): FREEPORT MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W STEPHENSON ST
FREEPORT IL
61032-4864
US

IV. Provider business mailing address

PO BOX 857
FREEPORT IL
61032-0857
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-6000
  • Fax: 815-599-7974
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MARK SIMON GRIDLEY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 815-599-6769