Organization
METHODIST MEDICAL CENTER OF ILLINOIS
Active
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
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 672-4887
(309) 671-2541
Mailing address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 672-5522
(309) 671-2541
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
0001594
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9960
BLUE CROSS PROVIDER NUM.
IL
Enumeration date
05/23/2006
Last updated
12/13/2019
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