Healthcare Provider Details

I. General information

NPI: 1790735421
Provider Name (Legal Business Name): SAINT JAMES HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W REYNOLDS ST
PONTIAC IL
61764-9774
US

IV. Provider business mailing address

124 SW ADAMS ST
PEORIA IL
61602-1320
US

V. Phone/Fax

Practice location:
  • Phone: 815-842-2828
  • Fax: 815-842-4912
Mailing address:
  • Phone: 309-655-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT C SEHRING
Title or Position: CEO
Credential:
Phone: 309-655-2850