Provider Demographics
NPI:1821380064
Name:OSF CHILDREN'S MEDICAL GROUP - CONGENITAL HEART CENTER, LLC
Entity Type:Organization
Organization Name:OSF CHILDREN'S MEDICAL GROUP - CONGENITAL HEART CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHOEPLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-655-2880
Mailing Address - Street 1:800 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3255
Mailing Address - Country:US
Mailing Address - Phone:309-655-2880
Mailing Address - Fax:
Practice Address - Street 1:5701 STRATHMOOR DR
Practice Address - Street 2:STE 1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5182
Practice Address - Country:US
Practice Address - Phone:815-227-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSF HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty