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General NPI Number Information
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NPI Number | 1184649410
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Entity Type | Organization
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Legal Business Name | OTTAWA MEDICAL CENTER, PC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 1614 E NORRIS DR
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City | OTTAWA
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State | IL
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Zip | 61350-3681
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Country | US
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Telephone | 815-433-1010
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Fax | 815-433-0067
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Provider Business Mailing Address
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Address Line | 1614 E NORRIS DR
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City | OTTAWA
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State | IL
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Zip | 61350-3681
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Country | US
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Telephone | 815-433-1010
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Fax | 815-433-0067
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Authorized Official
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Title or Position | ACCOUNTING CLERK
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Name | MRS. JILL L LOWE
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Credential |
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Telephone | 815-431-3265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 042-000502
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License Number State | IL
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