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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