Healthcare Provider Details

I. General information

NPI: 1437867256
Provider Name (Legal Business Name): ST. MARGARET'S HEALTH-PERU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CHARTRES ST
LA SALLE IL
61301-1097
US

IV. Provider business mailing address

925 WEST ST
PERU IL
61354-2757
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-0196
  • Fax: 815-223-0358
Mailing address:
  • Phone: 815-223-3300
  • Fax: 815-224-6763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA K LYNCH
Title or Position: VP FINANCE
Credential:
Phone: 815-780-3574