Provider Demographics
NPI:1114036308
Name:AHEARN & ASSOCIATES MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:AHEARN & ASSOCIATES MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-853-2442
Mailing Address - Street 1:519 ELLIOTT ST STE S1
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-2776
Mailing Address - Country:US
Mailing Address - Phone:309-853-2442
Mailing Address - Fax:309-853-2435
Practice Address - Street 1:513 ELLIOTT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-2797
Practice Address - Country:US
Practice Address - Phone:309-853-2442
Practice Address - Fax:309-853-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208011Medicare UPIN
IL148985Medicare Oscar/Certification
IL6174390001Medicare NSC