Healthcare Provider Details

I. General information

NPI: 1265532980
Provider Name (Legal Business Name): KEWANEE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W SOUTH STREET
KEWANEE IL
61443-9983
US

IV. Provider business mailing address

P.O. BOX 747 1051 W SOUTH STREET
KEWANEE IL
61443-9983
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-7500
  • Fax: 309-852-7591
Mailing address:
  • Phone: 309-852-7500
  • Fax: 309-852-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number0005538
License Number StateIL

VIII. Authorized Official

Name: MR. JOHN BOWSER
Title or Position: CFO
Credential:
Phone: 309-852-7522