Healthcare Provider Details

I. General information

NPI: 1407872997
Provider Name (Legal Business Name): MENDOTA COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/18/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 EAST 12TH STREET
MENDOTA IL
61342-9216
US

IV. Provider business mailing address

124 SW ADAMS ST
PEORIA IL
61602-1320
US

V. Phone/Fax

Practice location:
  • Phone: 815-539-7461
  • Fax: 815-538-5516
Mailing address:
  • Phone: 93-655-2850
  • Fax: 309-655-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0001537
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0001537
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0001537
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0001537
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0001537
License Number StateIL

VIII. Authorized Official

Name: ROBERT C. SEHRING
Title or Position: CEO, OSF HEALTHCARE SYSTEM
Credential:
Phone: 306-655-2850