Healthcare Provider Details

I. General information

NPI: 1528095510
Provider Name (Legal Business Name): ST. JOSEPH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/14/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 KLEEMAN DR.
CLINTON IL
61727
US

IV. Provider business mailing address

124 SW ADAMS ST
PEORIA IL
61602-1308
US

V. Phone/Fax

Practice location:
  • Phone: 800-589-6070
  • Fax:
Mailing address:
  • Phone: 309-655-2850
  • Fax: 309-655-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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