Healthcare Provider Details

I. General information

NPI: 1932148236
Provider Name (Legal Business Name): ST JOSEPH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E WASHINGTON ST
BLOOMINGTON IL
61701-4364
US

IV. Provider business mailing address

124 SW ADAMS ST
PEORIA IL
61602-1308
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-3311
  • Fax: 309-662-7143
Mailing address:
  • Phone: 309-655-2850
  • Fax: 309-655-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0002535
License Number StateIL

VIII. Authorized Official

Name: ROBERT C SEHRING
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 309-655-2850