Provider Demographics
NPI:1760542732
Name:SWEDISHAMERICAN HOSPITAL
Entity Type:Organization
Organization Name:SWEDISHAMERICAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEWANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:779-696-4009
Mailing Address - Street 1:1401 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2315
Mailing Address - Country:US
Mailing Address - Phone:815-391-7277
Mailing Address - Fax:815-391-7320
Practice Address - Street 1:1401 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2315
Practice Address - Country:US
Practice Address - Phone:815-391-7277
Practice Address - Fax:815-391-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002725225X00000X, 235Z00000X, 273R00000X, 282N00000X
273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation UnitGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN666847000Medicaid
MO010565109Medicaid
KS100101640AMedicaid
IA0902163Medicaid
ID000236800Medicaid
MA1008358Medicaid
MI304900699Medicaid
MI404900705Medicaid
IN100034030AMedicaid
AK108754105Medicaid
GA000680589XMedicaid
KY01332238Medicaid
CAXHSP33144IPMedicaid
FL091841500Medicaid
CO95006284Medicaid
IN100034030AMedicaid
MA1008358Medicaid
MN666847000Medicaid
IA0902163Medicaid
KS100101640AMedicaid