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NPI Code Detail

MEDICARE: SAINT ANTHONY MEDICAL CENTER

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 License Number License Number State
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110123444OTHERILBLUE CROSS

General Provider Information

NPI Number : 1679526628
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 : 4423 MANCHESTER DR
Second Line :
City : ROCKFORD
State : IL
Zip : 61109-1655
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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