MEDICARE: COMMUNITY MEDICAL CENTER OF WESTERN ILLINOIS INC

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	3140N1450X	Pediatric Skilled Nursing Facility

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14 5528	OTHER	IL	MEDICARE PART A

General Provider Information

NPI Number	:	1447239728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEDICAL CENTER OF WESTERN ILLINOIS INC

Provider Business Mailing Address
First Line	:	1000 W HARLEM AVENUE
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-1099
Country	:	US
Telephone Number	:	309-734-3141
Fax Number	:	309-734-3029

Provider Business Practice Location Address
First Line	:	1000 W HARLEM AVENUE
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-1099
Country	:	US
Telephone Number	:	309-734-3141
Fax Number	:	309-734-3029

Authorized Official
Title or Position	:	PROJECTS COORDINATOR
Name	:	MR. BRETT L STAHL
Credential	:
Telephone Number	:	309-734-1431

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	08/22/2020

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