Healthcare Provider Details

I. General information

NPI: 1760542732
Provider Name (Legal Business Name): SWEDISHAMERICAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

IV. Provider business mailing address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

V. Phone/Fax

Practice location:
  • Phone: 815-391-7277
  • Fax: 815-391-7320
Mailing address:
  • Phone: 815-391-7277
  • Fax: 815-391-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0002725
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0002725
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number0002725
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0002725
License Number StateIL

VIII. Authorized Official

Name: PATRICIA A DEWANE
Title or Position: VP FINANCE
Credential:
Phone: 779-696-4009