Basic Information
| Provider Information | |||||||||
| NPI: | 1215650528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IROQUOIS MEMORIAL HOSPITAL & RESIDENT HOME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 E FAIRMAN AVE | ||||||||
| Address2: | |||||||||
| City: | WATSEKA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609701644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154327775 | ||||||||
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| Practice Location | |||||||||
| Address1: | 135 W STATION ST | ||||||||
| Address2: | |||||||||
| City: | SAINT ANNE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609647251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154325841 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2022 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | FOX | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR MEDICAL STAFF & IT SVCS | ||||||||
| AuthorizedOfficialTelephone: | 8154325841 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.