Provider Demographics
NPI:1154644367
Name:KEWANEE HOSPITAL
Entity Type:Organization
Organization Name:KEWANEE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARKI
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMATIADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-852-7540
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-0747
Mailing Address - Country:US
Mailing Address - Phone:309-852-7500
Mailing Address - Fax:309-852-7552
Practice Address - Street 1:1051 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-8354
Practice Address - Country:US
Practice Address - Phone:309-852-7500
Practice Address - Fax:309-852-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002565273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========401Medicaid
IL141325Medicare Oscar/Certification