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General NPI Number Information
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NPI Number | 1780617530
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Entity Type | Organization
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Legal Business Name | JERSEY COMMUNITY HOSPITAL DISTRICT
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 400 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2028
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Country | US
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Telephone | 618-498-6402
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Fax |
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Provider Business Mailing Address
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Address Line | 400 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MICHELLE HOPPER
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Credential |
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Telephone | 618-498-8349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 001156
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 001156
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 001156
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License Number State | ID
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