Healthcare Provider Details

I. General information

NPI: 1659750818
Provider Name (Legal Business Name): JERSEY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 MAPLE SUMMIT RD MCDOW BLDG
JERSEYVILLE IL
62052-2004
US

IV. Provider business mailing address

390 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2000
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-7108
  • Fax: 618-498-7919
Mailing address:
  • Phone: 618-498-7518
  • Fax: 618-498-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0001156
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number0001156
License Number StateIL

VIII. Authorized Official

Name: MRS. MICHELLE A HOPPER
Title or Position: CFO
Credential:
Phone: 618-498-8349