Organization
MEMORIAL MEDICAL CENTER
Active
Other names
Anesthesia 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
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(217) 788-3000
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
453930
MEDICARE PTAN
IL
Enumeration date
08/07/2019
Last updated
06/17/2024
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