Provider Demographics
NPI:1508567298
Name:SAINT ANTHONY MEDICAL CENTER
Entity Type:Organization
Organization Name:SAINT ANTHONY MEDICAL CENTER
Other - Org Name:OSF HEALTHCARE - MEDICAL GROUP (NON-RHC BILLING)
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO, OSF HEALTHCARE SYSTEM
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-655-2850
Mailing Address - Street 1:124 SW ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1308
Mailing Address - Country:US
Mailing Address - Phone:309-655-2850
Mailing Address - Fax:309-655-4878
Practice Address - Street 1:9951 ROCK CUT XING
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-1999
Practice Address - Country:US
Practice Address - Phone:815-639-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSF HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-10
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL999Medicaid