Provider Demographics
NPI:1285720763
Name:SWEDISHAMERICAN HOSPITAL
Entity type:Organization
Organization Name:SWEDISHAMERICAN HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PATIENT SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GANTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-961-2030
Mailing Address - Street 1:2550 CHARLES ST STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1673
Mailing Address - Country:US
Mailing Address - Phone:779-696-7575
Mailing Address - Fax:815-391-7578
Practice Address - Street 1:2550 CHARLES ST STE A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1673
Practice Address - Country:US
Practice Address - Phone:779-696-7575
Practice Address - Fax:815-391-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054013179251F00000X
IL203.000157332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132144OtherBLUE CROSS BLUE SHIELD
IL10132144OtherBLUE CROSS BLUE SHIELD
IL0428510024Medicare NSC