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General NPI Number Information
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NPI Number | 1750752739
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Entity Type | Organization
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Legal Business Name | CGH MEDICAL CENTER
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 100 E LE FEVRE RD
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City | STERLING
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State | IL
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Zip | 61081-1278
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Country | US
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Telephone | 815-564-4633
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Fax | 815-632-5949
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Provider Business Mailing Address
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Address Line | 100 E LEFEVRE RD
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City | STERLING
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State | IL
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Zip | 61081-1278
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Country | US
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Telephone | 815-564-4633
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Fax | 815-632-5949
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | TIM DUNPHY
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Credential |
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Telephone | 815-564-4633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 054017388
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License Number State | IL
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