# METHODIST MEDICAL CENTER OF ILLINOIS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Methodist Anesthesia Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710198379
- **Authorized official:** STEPHEN M. CIRONE (REGIONAL MGR-REIMB/REV RECOGNITION)
- **Authorized official phone:** (309) 672-4813

## Contact information

- **Practice address:** 221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
- **Practice address phone:** (309) 672-5522
- **Mailing address:** 5271 RELIABLE PKWY, CHICAGO, IL 60686-0001
- **Mailing address phone:** (309) 672-5522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 05/25/2007
- **Last updated:** 02/14/2020