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General NPI Number Information
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NPI Number | 1568853018
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Entity Type | Organization
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Legal Business Name | ST ANTHONY'S PHYSICIAN ORGANIZATION OF ILLINOIS
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 509 HAMACHER ST STE 203
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City | WATERLOO
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State | IL
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Zip | 62298-1592
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Country | US
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Telephone | 618-939-0575
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Fax | 618-939-0577
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Provider Business Mailing Address
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Address Line | 509 HAMACHER ST STE 203
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City | WATERLOO
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State | IL
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Zip | 62298-1592
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Country | US
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Telephone | 618-939-0575
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Fax | 618-939-0577
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | KENNETH VENUTO
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Credential |
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Telephone | 314-525-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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