Healthcare Provider Details

I. General information

NPI: 1851764369
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: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 WEST ST SUITE 311
PERU IL
61354-2763
US

IV. Provider business mailing address

1305 6TH ST
PERU IL
61354-2759
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-9214
  • Fax: 815-223-9322
Mailing address:
  • Phone: 815-780-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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