MEDICARE: ST MARY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	0002675	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1164485363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	124 SW ADAMS ST
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61602-1308
Country	:	US
Telephone Number	:	309-655-2850
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 N SEMINARY ST
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-1251
Country	:	US
Telephone Number	:	309-344-3161
Fax Number	:	309-344-9498

Authorized Official
Title or Position	:	CFO
Name	:	KIRSTEN MARIE LARGENT
Credential	:
Telephone Number	:	309-308-5255

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	04/02/2026

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Directions to “ST MARY MEDICAL CENTER ” Practice Location

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