MEDICARE: MIDWEST HEALTH OPERATIONS LLC

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
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780670224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST HEALTH OPERATIONS LLC

Provider Business Mailing Address
First Line	:	830 W TRAILCREEK DRIVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614
Country	:	US
Telephone Number	:	309-691-8113
Fax Number	:	309-691-8622

Provider Business Practice Location Address
First Line	:	16827 1410 NORTH AVE
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-6871
Country	:	US
Telephone Number	:	815-875-1196
Fax Number	:	815-872-4408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK B PETERSEN
Credential	:
Telephone Number	:	309-691-8113

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/21/2010

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Directions to “MIDWEST HEALTH OPERATIONS LLC ” Practice Location

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