Provider Demographics
NPI:1568074714
Name:KIRBY MEDICAL CENTER
Entity Type:Organization
Organization Name:KIRBY MEDICAL CENTER
Other - Org Name:KIRBY RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:217-762-1870
Mailing Address - Fax:217-762-1555
Practice Address - Street 1:1402 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-8002
Practice Address - Country:US
Practice Address - Phone:217-762-3377
Practice Address - Fax:217-762-4499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIRBY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy