Organization
SWEDISHAMERICAN HOSPITAL
Active
Other names
SA Brookside Specialty Center
Organization subpart
No
Provider details
NPI number
Authorized official
DON DANIELS (VP)
(815) 966-2084
Entity
Organization
Contact information
Practice address
1253 N ALPINE RD, ROCKFORD, IL 61107
(779) 696-9201
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
207RR0500X
Rheumatology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207YP0228X
Pediatric Otolaryngology Physician
—
—
213E00000X
Podiatrist
—
—
231H00000X
Audiologist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D1001046
CLIA
IL
Enumeration date
12/14/2006
Last updated
07/12/2018
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