Healthcare Provider Details

I. General information

NPI: 1609685189
Provider Name (Legal Business Name): METHODIST MEDICAL CENTER OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 N UNIVERSITY ST
PEORIA IL
61614-3453
US

IV. Provider business mailing address

221 NE GLEN OAK AVE
PEORIA IL
61636-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-6650
  • Fax:
Mailing address:
  • Phone: 309-672-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH KNEPP
Title or Position: PRESIDENT
Credential: M.D.
Phone: 309-671-2528