Provider Demographics
NPI:1093715799
Name:COUNTY OF MERCER HOSPITAL
Entity Type:Organization
Organization Name:COUNTY OF MERCER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-582-5301
Mailing Address - Street 1:409 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1258
Mailing Address - Country:US
Mailing Address - Phone:309-582-5301
Mailing Address - Fax:309-582-3744
Practice Address - Street 1:409 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1258
Practice Address - Country:US
Practice Address - Phone:309-582-5301
Practice Address - Fax:309-582-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0003772282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0194OtherBLUE CROSS
IL0006615001OtherBLUE SHIELD
IL0006615001OtherBLUE SHIELD
IL0194OtherBLUE CROSS