Provider Demographics
NPI:1992773873
Name:HARRISBURG MEDICAL CENTER INC
Entity type:Organization
Organization Name:HARRISBURG MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-253-7671
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-0250
Mailing Address - Country:US
Mailing Address - Phone:618-273-7723
Mailing Address - Fax:618-273-3384
Practice Address - Street 1:1007 US ROUTE 45
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930
Practice Address - Country:US
Practice Address - Phone:618-273-7723
Practice Address - Fax:618-273-3384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRISBURG MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-08
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000521261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143471OtherHEALTHLINK
IL8315011OtherBLUE CROSS PROVIDER NUMBE
IL817400OtherWPS PROVIDER NUMBER
IL817400OtherWPS PROVIDER NUMBER