MEDICARE: ST. MARGARET'S HEALTH-PERU

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1932440625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARGARET'S HEALTH-PERU

Provider Business Mailing Address
First Line	:	1305 6TH ST
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354-2759
Country	:	US
Telephone Number	:	815-780-4619
Fax Number	:	815-780-3836

Provider Business Practice Location Address
First Line	:	920 WEST ST STE 218
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354-2769
Country	:	US
Telephone Number	:	815-780-3838
Fax Number	:	815-780-3836

Authorized Official
Title or Position	:	DIRECTOR OF PHYSICIAN PRACTICES
Name	:	DORI BONNELL
Credential	:
Telephone Number	:	815-780-3838

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	01/28/2021

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