Provider Demographics
NPI:1073580130
Name:HARRISBURG MEDICAL CENTER INC
Entity type:Organization
Organization Name:HARRISBURG MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-253-7671
Mailing Address - Street 1:100 DR WARREN TUTTLE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2718
Mailing Address - Country:US
Mailing Address - Phone:618-253-7671
Mailing Address - Fax:618-252-3763
Practice Address - Street 1:100 DR WARREN TUTTLE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2718
Practice Address - Country:US
Practice Address - Phone:618-253-7671
Practice Address - Fax:618-252-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000521282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143471OtherHEALTHLINK PROVIDER NUMBE
IL3575OtherHEALTH ALLIANCE
IL364OtherBLUE CROSS PROVIDER NUMBE
IL=========001Medicaid
IL143471OtherHEALTHLINK PROVIDER NUMBE