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General NPI Number Information
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NPI Number | 1629003470
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Entity Type | Organization
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Legal Business Name | IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 200 E FAIRMAN AVE
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City | WATSEKA
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State | IL
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Zip | 60970-1644
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Country | US
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Telephone | 815-432-5841
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Fax | 815-432-7821
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Provider Business Mailing Address
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Address Line | 200 E FAIRMAN AVE
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City | WATSEKA
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State | IL
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Zip | 60970-1644
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Country | US
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Telephone | 815-432-5841
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Fax | 815-432-7821
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Authorized Official
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Title or Position | DIRECTOR MEDICAL STAFF & IT SVCS
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Name | MRS. MICHELLE FOX
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Credential |
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Telephone | 815-432-7775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 0001107
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State |
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