Healthcare Provider Details

I. General information

NPI: 1538543251
Provider Name (Legal Business Name): OSF SAINT FRANCIS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

3621 N SANDIA DR
PEORIA IL
61604-1046
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-3863
  • Fax:
Mailing address:
  • Phone: 224-402-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.066959
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.066959
License Number StateIL

VIII. Authorized Official

Name: MARIA F SAAVEDRA
Title or Position: RESIDENT PHYSICIAN
Credential: M.D.
Phone: 224-402-5999