| Organization Name: | METHODIST MEDICAL CENTER OF ILLINOIS |
| NPI Number: | 1790737385 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CALVIN MACKAY (CHIEF FINANCIAL OFFICER/SENIOR VP) |
| Mailing Address: | 221 Ne Glen Oak Ave Peoria |
| State: | IL US |
| Postal Code: | 616360001 |
| Phone Number: | 3096724887 |
| Fax Number: | 3096712541 |
| NPI Enumeration Date: | 05/16/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 0001594 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |