Healthcare Provider Details

I. General information

NPI: 1215914122
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTER OF WESTERN IL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WEST HARLEM AVE
MONMOUTH IL
61462-1099
US

IV. Provider business mailing address

1000 WEST HARLEM AVE
MONMOUTH IL
61462-1099
US

V. Phone/Fax

Practice location:
  • Phone: 309-734-3141
  • Fax: 309-734-3029
Mailing address:
  • Phone: 309-734-3141
  • Fax: 309-734-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number000429
License Number StateIL

VIII. Authorized Official

Name: MR. BRETT L STAHL
Title or Position: PROJECTS COORDINATOR
Credential:
Phone: 309-734-1431