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General NPI Number Information
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NPI Number | 1588952766
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Entity Type | Organization
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Legal Business Name | HENRY HOSPITAL DISTRICT
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 600 N COLLEGE AVE
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City | GENESEO
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State | IL
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Zip | 61254-1091
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Country | US
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Telephone | 309-944-6431
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Fax |
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Provider Business Mailing Address
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Address Line | 1970 SPRUCE HILLS DR
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City | BETTENDORF
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State | IA
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Zip | 52722-2681
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Country | US
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Telephone | 563-345-6788
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRAD SOLBERG
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Credential |
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Telephone | 309-944-6431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 125-052576
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License Number State | IL
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