Organization
MEMORIAL MEDICAL CENTER
Active
Other names
Professional Fees
Organization subpart
No
Provider details
NPI number
Authorized official
ANN BOWLING (DIRECTOR)
(217) 588-2626
Entity
Organization
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3000
Mailing address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG7164
RAILROAD MEDICARE PROVIDER NUMBER
IL
Enumeration date
04/05/2006
Last updated
06/14/2024
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