Provider Demographics
NPI:1215961818
Name:COUNTY OF MERCER HOSPITAL
Entity type:Organization
Organization Name:COUNTY OF MERCER HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-582-3700
Mailing Address - Street 1:1007 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1296
Mailing Address - Country:US
Mailing Address - Phone:309-582-3700
Mailing Address - Fax:309-582-3737
Practice Address - Street 1:1007 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1296
Practice Address - Country:US
Practice Address - Phone:309-582-3700
Practice Address - Fax:309-582-3737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MERCER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006632002OtherBLUE CROSS OF IL
210481OtherMEDICARE B
IL825050OtherMEDICARE B
IL0006632002OtherBLUE CROSS OF IL
IL=========007Medicaid