Provider Demographics
NPI:1790706448
Name:ST. MARGARET'S HEALTH-PERU
Entity Type:Organization
Organization Name:ST. MARGARET'S HEALTH-PERU
Other - Org Name:SMH-PERU ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-780-3574
Mailing Address - Street 1:925 WEST ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2757
Mailing Address - Country:US
Mailing Address - Phone:815-223-3300
Mailing Address - Fax:815-224-6763
Practice Address - Street 1:925 WEST ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2757
Practice Address - Country:US
Practice Address - Phone:815-223-3300
Practice Address - Fax:815-224-6763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========401Medicaid
IL=========401Medicaid