1831521947 NPI number — ST. MARGARET'S HEALTH-PERU

Table of content: (NPI 1831521947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831521947 NPI number — ST. MARGARET'S HEALTH-PERU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARGARET'S HEALTH-PERU
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IVCH MEDICAL GROUP / ENT & ALLERGY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831521947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERU
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61354-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-780-5030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 WEST ST
Provider Second Line Business Practice Location Address:
SUTIE 312
Provider Business Practice Location Address City Name:
PERU
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61354-2763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-223-4400
Provider Business Practice Location Address Fax Number:
815-223-4401
Provider Enumeration Date:
07/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BONNELL
Authorized Official First Name:
DORI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHYSICIAN PRACTICES
Authorized Official Telephone Number:
815-780-3222

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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