Healthcare Provider Details

I. General information

NPI: 1487978227
Provider Name (Legal Business Name): MIDWEST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SUMMIT ST
GALENA IL
61036-1635
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
GALENA IL
61036-8118
US

V. Phone/Fax

Practice location:
  • Phone: 815-776-7255
  • Fax: 815-776-7298
Mailing address:
  • Phone: 815-777-1340
  • Fax: 815-776-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0049718
License Number StateIL

VIII. Authorized Official

Name: MS. MARY R SHEAHEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 815-776-7266