Healthcare Provider Details

I. General information

NPI: 1073580130
Provider Name (Legal Business Name): HARRISBURG MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DR WARREN TUTTLE DR
HARRISBURG IL
62946-2718
US

IV. Provider business mailing address

100 DR WARREN TUTTLE DR
HARRISBURG IL
62946-2718
US

V. Phone/Fax

Practice location:
  • Phone: 618-253-7671
  • Fax: 618-252-3763
Mailing address:
  • Phone: 618-253-7671
  • Fax: 618-252-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000521
License Number StateIL

VIII. Authorized Official

Name: DONALD HUTSON
Title or Position: CEO/PRESIDENT
Credential:
Phone: 618-253-7671