Healthcare Provider Details

I. General information

NPI: 1255654430
Provider Name (Legal Business Name): KEWANEE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W SOUTH ST
KEWANEE IL
61443-8354
US

IV. Provider business mailing address

PO BOX 747
KEWANEE IL
61443-0747
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-7500
  • Fax: 309-852-7552
Mailing address:
  • Phone: 309-852-7500
  • Fax: 309-852-7552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number242001340
License Number StateIL

VIII. Authorized Official

Name: MRS. MARKI STAMATIADES
Title or Position: BUSINESS OFFICE DIRECTOR
Credential:
Phone: 309-852-7540