Organization
SWEDISHAMERICAN HOSPITAL
Active
Organization
SWEDISHAMERICAN HOSPITAL
Active
Other names
SwedishAmerican Infusion Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANN M GANTZER (VICE PRESIDENT OF PATIENT SERVICES)
(815) 961-2030
Entity
Organization
Contact information
Practice address
2550 CHARLES ST STE A, ROCKFORD, IL 61108-1673
(779) 696-7575
(815) 391-7578
Mailing address
2550 CHARLES ST STE A, ROCKFORD, IL 61108-1673
(779) 696-7575
(815) 391-7578
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
054013179
IL
332B00000X
Durable Medical Equipment & Medical Supplies
203.000157
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10132144
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/04/2006
Last updated
02/06/2015
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