Organization
SWEDISHAMERICAN HOSPITAL
Active
Other names
SA Freeport Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DON DANIELS (VP)
(815) 966-2084
Entity
Organization
Contact information
Practice address
1036 W STEPHENSON ST, FREEPORT, IL 61032
(877) 277-6770
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
064
TRICARE SUFFIX #
IL
Enumeration date
11/25/2009
Last updated
07/12/2018
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