Provider Demographics
NPI:1932157492
Name:SHERMAN HOSPITAL
Entity Type:Organization
Organization Name:SHERMAN HOSPITAL
Other - Org Name:SHERMAN HOSPITAL NUCLEAR MEDICINE IDTF
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-429-8718
Mailing Address - Street 1:934 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2125
Mailing Address - Country:US
Mailing Address - Phone:847-742-9800
Mailing Address - Fax:
Practice Address - Street 1:2320 ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4717
Practice Address - Country:US
Practice Address - Phone:847-429-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002162261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213236Medicare ID - Type UnspecifiedROYAL-IDTF