MEDICARE: HAMMOND HENRY DIST 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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1770152779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMMOND HENRY DIST HOSPITAL

Provider Business Mailing Address
First Line	:	600 N COLLEGE AVE
Second Line	:
City	:	GENESEO
State	:	IL
Zip	:	61254-1091
Country	:	US
Telephone Number	:	309-944-9123
Fax Number	:	309-944-9272

Provider Business Practice Location Address
First Line	:	106 N EAST ST
Second Line	:
City	:	CAMBRIDGE
State	:	IL
Zip	:	61238-1157
Country	:	US
Telephone Number	:	309-853-3677
Fax Number	:	309-520-2568

Authorized Official
Title or Position	:	VP OF FISCAL SERVICES
Name	:	JODIE L CRISWELL
Credential	:
Telephone Number	:	309-944-9103

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	02/18/2026

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