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General NPI Number Information
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NPI Number | 1912253568
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Entity Type | Organization
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Legal Business Name | PROVENA MERCY MEDICAL CENTER
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 136 SPUHLER DR
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City | BATAVIA
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State | IL
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Zip | 60510-1625
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Country | US
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Telephone | 630-879-1969
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Fax |
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Provider Business Mailing Address
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Address Line | 136 SPUHLER DR
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City | BATAVIA
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State | IL
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Zip | 60510-1625
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Country | US
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Telephone | 630-879-1969
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. VIRGENE GALLOWAY
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Credential | OTR/L
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Telephone | 630-907-0263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 056.002553
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License Number State | IL
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