Healthcare Provider Details

I. General information

NPI: 1225283849
Provider Name (Legal Business Name): GERMANTOWN HILLS MEDICAL CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 ELIZABETH POINTE DR
GERMANTOWN HILLS IL
61548-9471
US

IV. Provider business mailing address

107 ELIZABETH POINTE DR
GERMANTOWN HILLS IL
61548-9471
US

V. Phone/Fax

Practice location:
  • Phone: 309-383-2323
  • Fax: 309-383-2367
Mailing address:
  • Phone: 309-383-2323
  • Fax: 309-383-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036100702
License Number StateIL

VIII. Authorized Official

Name: DR. JOHN CHRISTOPHER KELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 309-383-2323