Basic Information
| Provider Information | |||||||||
| NPI: | 1073565669 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METHODIST MEDICAL CENTER OF ILLINOIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 NE GLEN OAK AVE | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096724874 | ||||||||
| FaxNumber: | 3096712541 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 NE GLEN OAK AVE | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096725522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 02/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCMILLION | ||||||||
| AuthorizedOfficialFirstName: | CARRIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ANALYST - FINANCIAL OPEARTIONS | ||||||||
| AuthorizedOfficialTelephone: | 0967248743 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 02/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0001594 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.