Organization
KATHERINE SHAW BETHEA HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUSTIN BRUCE FRAZIER (CFO)
(815) 285-5521
Entity
Organization
Contact information
Practice address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 288-5521
(815) 285-5859
Mailing address
PO BOX 841330, KANSAS CITY, MO 64184-1330
(816) 201-3331
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0000497
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0192
BLUE CROSS
IL
Enumeration date
09/14/2005
Last updated
12/29/2022
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