Basic Information
| Provider Information | |||||||||
| NPI: | 1366480873 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOOPESTON COMMUNITY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 E ORANGE ST | ||||||||
| Address2: | |||||||||
| City: | HOOPESTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609421801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173836792 | ||||||||
| FaxNumber: | 2173834752 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 E ORANGE ST | ||||||||
| Address2: | |||||||||
| City: | HOOPESTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609421801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172835531 | ||||||||
| FaxNumber: | 2172837981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 11/27/2013 | ||||||||
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| AuthorizedOfficialLastName: | BROCKUS | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2172838540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 0004200 | IL | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 005 | 01 | IL | BCBS ACUTE | OTHER | 131734500 | 01 | IL | DEPARTMENT OF LABOR | OTHER | 09215199 | 01 | IL | BCBS PC | OTHER |