# IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME

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- **Entity:** Organization
- **Status:** Active
- **Other names:** IMH Multi-Specialty Physicians
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790889194
- **Authorized official:** CHUCK BOHLMANN (PRESIDENT/CEO)
- **Authorized official phone:** (815) 432-7736

## Contact information

- **Practice address:** 200 LAIRD LN, WATSEKA, IL 60970-7568
- **Practice address phone:** (815) 432-5411
- **Practice address fax:** (815) 432-3955
- **Mailing address:** 200 LAIRD LN, WATSEKA, IL 60970-7568
- **Mailing address phone:** (815) 432-5411
- **Mailing address fax:** (815) 432-3955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/07/2006
- **Last updated:** 09/19/2014