Organization · Type 2 NPI

Iroquois Memorial Hospital and Resident Home

General Practice Physician · St. Anne, IL

NPI number 1215650528 Active

Practice location

135 W Station St
St. Anne, IL 60964-7251

Call (815) 432-5841 Map

Mailing address

200 E Fairman Ave
Watseka, IL 60970-1644

Specialties and licenses

Taxonomy	Code	License
General Practice Physician Primary	208D00000X	None listed

General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Another provider at this address

Sergey Shushunov, MDPediatric Critical Care Medicine Physician St. Anne, IL NPI 1588632681

NPI record

NPI: 1215650528
Entity type: Organization (Type 2)
Issued: Sep 21, 2022
Last updated: May 26, 2023
Status: Active

Other names

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Imh St. Anne Clinic · doing business as
Imh St. Anne Clinic · doing business as

Authorized official

Michelle Fox
Director Medical Staff & IT SVCS
(815) 432-5841

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1215650528

Iroquois Memorial Hospital and Resident Home's National Provider Identifier is 1215650528, issued on Sep 21, 2022. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in St. Anne, IL. The record was last updated on May 26, 2023.