Healthcare Provider Details

I. General information

NPI: 1427421924
Provider Name (Legal Business Name): ST. MARGARET'S HEALTH-PERU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W WALNUT ST
OGLESBY IL
61348-1400
US

IV. Provider business mailing address

1305 6TH ST
PERU IL
61354-2759
US

V. Phone/Fax

Practice location:
  • Phone: 815-883-3588
  • Fax: 815-883-2604
Mailing address:
  • Phone: 815-780-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number085005712
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number085005712
License Number StateIL

VIII. Authorized Official

Name: DORINDA BONNELL
Title or Position: DIRECTOR OF PHYSICIAN PRACTICES
Credential:
Phone: 815-780-3222