Provider Demographics
NPI:1639246317
Name:ST. MARGARET'S HEALTH - SPRING VALLEY
Entity Type:Organization
Organization Name:ST. MARGARET'S HEALTH - SPRING VALLEY
Other - Org Name:ST MARGARETS HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-664-5311
Mailing Address - Street 1:416 E DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-2235
Mailing Address - Country:US
Mailing Address - Phone:815-664-1503
Mailing Address - Fax:
Practice Address - Street 1:416 E DAKOTA ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-2235
Practice Address - Country:US
Practice Address - Phone:815-664-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000660332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========005Medicaid
0743790003Medicare NSC