Provider Demographics
NPI:1437314952
Name:OSF SAINT FRANCIS, INC
Entity Type:Organization
Organization Name:OSF SAINT FRANCIS, INC
Other - Org Name:OSF HOME MEDICAL EQUIPMENT - BLOOMINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:J
Authorized Official - Last Name:QUERCIAGROSSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-683-7850
Mailing Address - Street 1:2265 W ALTORFER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1807
Mailing Address - Country:US
Mailing Address - Phone:309-665-4765
Mailing Address - Fax:
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:309-665-4765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSF HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-24
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========015Medicaid
IL0387470013Medicare NSC