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General NPI Number Information
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NPI Number | 1629118609
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Entity Type | Organization
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Legal Business Name | JAVON BEA HOSPITAL
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 8201 E RIVERSIDE BLVD
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City | ROCKFORD
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State | IL
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Zip | 61114-2300
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Country | US
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Telephone | 815-971-7000
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Fax | 815-968-4795
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Provider Business Mailing Address
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Address Line | 2400 N ROCKTON AVE
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City | ROCKFORD
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State | IL
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Zip | 61103-3655
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Country | US
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Telephone | 608-314-2428
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Fax | 815-968-0170
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Authorized Official
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Title or Position | CFO
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Name | JOSEPH D MALAS
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Credential |
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Telephone | 815-971-6738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 0002048
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License Number State | IL
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