Healthcare Provider Details

I. General information

NPI: 1588623318
Provider Name (Legal Business Name): KISHWAUKEE COMMUNITY HEALTH SERVICES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 GATEWAY DR
SYCAMORE IL
60178
US

IV. Provider business mailing address

2240 GATEWAY DR
SYCAMORE IL
60178
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-8571
  • Fax: 815-756-1226
Mailing address:
  • Phone: 815-756-8571
  • Fax: 815-756-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA SYKES
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 815-756-8574