Provider Demographics
NPI:1508219288
Name:KIRBY MEDICAL CENTER
Entity Type:Organization
Organization Name:KIRBY MEDICAL CENTER
Other - Org Name:CERRO GORDO RURAL HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TENHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-762-1501
Mailing Address - Street 1:1000 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-2116
Mailing Address - Country:US
Mailing Address - Phone:217-762-1540
Mailing Address - Fax:217-762-1542
Practice Address - Street 1:407 SOUTH JACKSON STREET
Practice Address - Street 2:SUITE A
Practice Address - City:CERRO GORDO
Practice Address - State:IL
Practice Address - Zip Code:61818-4356
Practice Address - Country:US
Practice Address - Phone:217-763-6010
Practice Address - Fax:217-763-6012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIRBY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-19
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health