Organization
METHODIST MEDICAL CENTER OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH KNEPP DO (CEO)
(309) 671-2528
Entity
Organization
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636
(309) 672-5522
Mailing address
221 NE GLEN OAK AVE, GOMP 100, PEORIA, IL 61636-0001
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0001594
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0116
BLUE CROSS PROV. NUMBER
IL
Enumeration date
05/16/2006
Last updated
03/28/2023
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