Organization
FREEPORT REGIONAL HEALTH CARE FOUNDATION
Active
Other names
FHN
Organization subpart
No
Provider details
NPI number
Authorized official
MARK S GRIDLEY (CHIEF EXECUTIVE OFFICER)
(815) 599-6769
Entity
Organization
Contact information
Practice address
1036 W STEPHENSON ST, FREEPORT, IL 61032-4865
(815) 599-6000
Mailing address
421 W EXCHANGE ST, PO BOX 268, FREEPORT, IL 61032-4008
(815) 599-7925
(815) 599-7923
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208600000X
Surgery Physician
—
—
225X00000X
Occupational Therapist
—
—
261QX0203X
Radiation Oncology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08923833
BLUE CROSS
IL
Enumeration date
12/15/2005
Last updated
07/17/2017
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