Healthcare Provider Details

I. General information

NPI: 1336051259
Provider Name (Legal Business Name): METHODIST MEDICAL CENTER OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N KNOXVILLE AVE STE 104
PEORIA IL
61614-5021
US

IV. Provider business mailing address

5401 N KNOXVILLE AVE STE 104
PEORIA IL
61614-5021
US

V. Phone/Fax

Practice location:
  • Phone: 309-643-6205
  • Fax: 309-999-5722
Mailing address:
  • Phone: 309-643-6205
  • Fax: 309-999-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARON KLEIN
Title or Position: VP FINANCIAL SERVICES
Credential:
Phone: 217-902-5814