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Organization
METHODIST MEDICAL CENTER OF ILLINOIS
Active
Organization
METHODIST MEDICAL CENTER OF ILLINOIS
Active
Other names
Methodist Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN M. CIRONE (REGIONAL MGR-REIMB/REV RECOGNITION)
(309) 672-4813
Entity
Organization
Contact information
Practice address
120 NE GLEN OAK AVE, SUITE 101, PEORIA, IL 61603
(309) 671-8230
(309) 671-5118
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0051
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7215059
BCBS PPO
IL
Enumeration date
05/26/2006
Last updated
02/14/2020
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