Organization
KATHERINE SHAW BETHEA HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VERNON FARRELL (VICE PRESIDENT OF FINANCE)
(815) 285-5511
Entity
Organization
Contact information
Practice address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 288-5531
Mailing address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 288-5531
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
0000497
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05215223
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
09/20/2005
Last updated
08/22/2020
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