Provider Demographics
NPI:1689859795
Name:EUREKA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:EUREKA COMMUNITY HOSPITAL
Other - Org Name:ECH URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CERMAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-268-5180
Mailing Address - Street 1:101 S MAJOR ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1246
Mailing Address - Country:US
Mailing Address - Phone:309-467-4004
Mailing Address - Fax:
Practice Address - Street 1:101 S MAJOR ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1246
Practice Address - Country:US
Practice Address - Phone:309-467-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROMENN HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0003574261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL801140OtherMEDICARE PART B