Organization
MCDONOUGH COUNTY HOSPITAL DISTRICT
Active
Organization
MCDONOUGH COUNTY HOSPITAL DISTRICT
Active
Other names
McDonough District Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN E DIETZ (PRESIDENT, CEO)
(309) 833-4101
Entity
Organization
Contact information
Practice address
525 E GRANT ST, MACOMB, IL 61455-3313
(309) 833-4101
Mailing address
525 E GRANT ST, MACOMB, IL 61455-3313
(309) 833-4101
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005519699
BLUE SHIELD GROUP
IL
Enumeration date
05/24/2007
Last updated
10/17/2023
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