Provider Demographics
NPI:1427193580
Name:FREEPORT REGIONAL HEALTH CARE FOUNDATION
Entity Type:Organization
Organization Name:FREEPORT REGIONAL HEALTH CARE FOUNDATION
Other - Org Name:FHN FAMILY HEALTHCARE CENTER HARLEM AVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-599-6000
Mailing Address - Street 1:421 W EXCHANGE ST
Mailing Address - Street 2:PO BOX 268
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4030
Mailing Address - Country:US
Mailing Address - Phone:815-599-7958
Mailing Address - Fax:
Practice Address - Street 1:25 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-3801
Practice Address - Country:US
Practice Address - Phone:815-599-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL582630Medicare ID - Type UnspecifiedGROUP
IL433440Medicare ID - Type UnspecifiedGROUP
IL207602Medicare ID - Type UnspecifiedGROUP
IL1312400012Medicare NSC