Organization
OTTAWA MEDICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL L LOWE (ACCOUNTING CLERK)
(815) 431-3265
Entity
Organization
Contact information
Practice address
1614 E NORRIS DR, OTTAWA, IL 61350-3681
(815) 431-3265
(815) 431-3259
Mailing address
1614 E NORRIS DR, OTTAWA, IL 61350-3681
(815) 431-3265
(815) 431-3259
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
9032426
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
159632
FDA FACILITY ID NUMBER
—
Enumeration date
11/20/2006
Last updated
08/22/2020
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