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NPI Code Detail

MEDICARE: MIDWEST HEALTH OPERATIONS, LLC

MEDICARE: MIDWEST HEALTH OPERATIONS, LLC
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
1314000000XSkilled Nursing Facility0052225IL

General Provider Information

NPI Number : 1841539749
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST HEALTH OPERATIONS, LLC
Provider Business Mailing Address
First Line : 830 W TRAILCREEK DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-1862
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5533 N GALENA RD
Second Line :
City : PEORIA HEIGHTS
State : IL
Zip : 61616-4447
Country : US
Telephone Number : 309-682-5428
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MARK PETERSEN
Credential :
Telephone Number : 309-691-8113
Provider Enumeration Date : 02/12/2013
Last Update Date : 06/20/2013

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Directions to “MIDWEST HEALTH OPERATIONS, LLC ” Practice Location

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