MEDICARE: SAINT ANTHONY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10123444	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1003869967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT ANTHONY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	124 SW ADAMS ST
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61602-1308
Country	:	US
Telephone Number	:	309-655-2850
Fax Number	:	309-655-4878

Provider Business Practice Location Address
First Line	:	556 E GRANT HWY
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-3346
Country	:	US
Telephone Number	:	800-589-6070
Fax Number	:	309-683-5969

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT C SEHRING
Credential	:
Telephone Number	:	309-655-2850

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/07/2024

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Directions to “SAINT ANTHONY MEDICAL CENTER ” Practice Location

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