Organization
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Active
Other names
IMH Gilman Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY SMITH (COO)
(815) 432-7967
Entity
Organization
Contact information
Practice address
508 E CRESCENT ST, GILMAN, IL 60938-1702
(812) 265-8889
(815) 265-8332
Mailing address
508 E CRESCENT ST, GILMAN, IL 60938-1702
(812) 265-8889
(815) 265-8332
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003815088
BCBS OF IL
IL
Enumeration date
07/16/2006
Last updated
01/17/2017
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