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1629118609

NPI Code Detail

MEDICARE: JAVON BEA HOSPITAL

MEDICARE: JAVON BEA HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	282N00000X	General Acute Care Hospital	0002048	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	140239	OTHER	IL	IL MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	372	OTHER		BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629118609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAVON BEA HOSPITAL

Provider Business Mailing Address
First Line	:	2400 N ROCKTON AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61103-3655
Country	:	US
Telephone Number	:	608-314-2428
Fax Number	:	815-968-0170

Provider Business Practice Location Address
First Line	:	8201 E RIVERSIDE BLVD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-2300
Country	:	US
Telephone Number	:	815-971-7000
Fax Number	:	815-968-4795

Authorized Official
Title or Position	:	CFO
Name	:	JOSEPH D MALAS
Credential	:
Telephone Number	:	815-971-6738

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	02/05/2026

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Directions to “JAVON BEA HOSPITAL ” Practice Location

Language	Start Address	Practice Location

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