Healthcare Provider Details

I. General information

NPI: 1285720763
Provider Name (Legal Business Name): SWEDISHAMERICAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 CHARLES ST STE A
ROCKFORD IL
61108-1673
US

IV. Provider business mailing address

2550 CHARLES ST STE A
ROCKFORD IL
61108-1673
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-7575
  • Fax: 815-391-7578
Mailing address:
  • Phone: 779-696-7575
  • Fax: 815-391-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number054013179
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203.000157
License Number StateIL

VIII. Authorized Official

Name: MS. ANN M GANTZER
Title or Position: VICE PRESIDENT OF PATIENT SERVICES
Credential:
Phone: 815-961-2030