Healthcare Provider Details

I. General information

NPI: 1316698319
Provider Name (Legal Business Name): HAMMOND HENRY DIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 DIVISION ST
ORION IL
61273-7715
US

IV. Provider business mailing address

600 N COLLEGE AVE
GENESEO IL
61254-1091
US

V. Phone/Fax

Practice location:
  • Phone: 309-944-6431
  • Fax:
Mailing address:
  • Phone: 309-944-9123
  • Fax: 309-944-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODIE L CRISWELL
Title or Position: VP OF FISCAL SERVICES
Credential:
Phone: 309-944-9103