Basic Information
| Provider Information | |||||||||
| NPI: | 1902073521 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CGH MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E LEFEVRE RD | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610811278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156250400 | ||||||||
| FaxNumber: | 8156262896 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E LEFEVRE RD | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610811278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156250400 | ||||||||
| FaxNumber: | 8156262896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | VELAZQUEZ | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT DIRECTOR PATIENT ACCOUNTS | ||||||||
| AuthorizedOfficialTelephone: | 8155644502 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | IL | Y | Transportation Services | Ambulance |
No ID Information.