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General NPI Number Information
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NPI Number | 1225877590
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Entity Type | Organization
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Legal Business Name | MENDOTA COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 309 S MCCOY ST
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City | GRANVILLE
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State | IL
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Zip | 61326-9333
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Country | US
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Telephone | 815-538-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 124 SW ADAMS ST
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City | PEORIA
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State | IL
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Zip | 61602-1308
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Country | US
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Telephone | 309-655-2850
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ROBERT CARL SEHRING
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Credential |
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Telephone | 309-655-7689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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