Provider Demographics
NPI:1427001445
Name:MERCY HARVARD HOSPITAL INC
Entity Type:Organization
Organization Name:MERCY HARVARD HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-971-6752
Mailing Address - Street 1:901 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-1821
Mailing Address - Country:US
Mailing Address - Phone:815-943-5431
Mailing Address - Fax:815-943-2726
Practice Address - Street 1:901 GRANT ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-1821
Practice Address - Country:US
Practice Address - Phone:815-943-5431
Practice Address - Fax:815-943-2726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCYHEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4911225X00000X, 261QP2000X
IL0004911282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11002000Medicaid
IL00196OtherBCBSIL
IL00196OtherBCBSIL
IL=========403Medicaid
IL00196OtherBCBSIL
IL214660Medicare Oscar/Certification