Provider Demographics
NPI:1902843261
Name:HAMMOND-HENRY HEALTH ALLIANCE
Entity Type:Organization
Organization Name:HAMMOND-HENRY HEALTH ALLIANCE
Other - Org Name:MAGNUS ORTHOPEADICS GENESEO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:SOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-944-6431
Mailing Address - Street 1:600 N COLLEGE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1091
Mailing Address - Country:US
Mailing Address - Phone:309-944-6431
Mailing Address - Fax:309-944-9299
Practice Address - Street 1:600 N COLLEGE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1091
Practice Address - Country:US
Practice Address - Phone:309-944-6431
Practice Address - Fax:309-944-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00264233OtherRR MEDICARE
ILF32665Medicare UPIN
ILP00264233OtherRR MEDICARE