Healthcare Provider Details

I. General information

NPI: 1730179847
Provider Name (Legal Business Name): KIRBY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER DR
MONTICELLO IL
61856-2116
US

IV. Provider business mailing address

1000 MEDICAL CENTER DR
MONTICELLO IL
61856-2116
US

V. Phone/Fax

Practice location:
  • Phone: 217-762-2115
  • Fax: 217-762-1531
Mailing address:
  • Phone: 217-762-2115
  • Fax: 217-762-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0002758
License Number StateIL

VIII. Authorized Official

Name: MR. STEVEN DALE TENHOUSE
Title or Position: CEO
Credential:
Phone: 217-762-1501