Healthcare Provider Details

I. General information

NPI: 1851330203
Provider Name (Legal Business Name): ST JOSEPH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/14/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E COLLEGE AVE
BLOOMINGTON IL
61704-2101
US

IV. Provider business mailing address

124 SW ADAMS ST
PEORIA IL
61602-1320
US

V. Phone/Fax

Practice location:
  • Phone: 309-451-5925
  • Fax: 309-451-8278
Mailing address:
  • Phone: 309-655-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT C. SEHRING
Title or Position: CEO OSF HEALTHCARE SYSTEM
Credential:
Phone: 309-655-2850