Provider Demographics
NPI:1861479776
Name:COMMUNITY MEDICAL CENTER OF WESTERN IL INC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTER OF WESTERN IL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECTS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-734-1431
Mailing Address - Street 1:1000 WEST HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-1099
Mailing Address - Country:US
Mailing Address - Phone:309-734-3141
Mailing Address - Fax:309-734-3029
Practice Address - Street 1:1000 WEST HARLEM AVE
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1099
Practice Address - Country:US
Practice Address - Phone:309-734-3141
Practice Address - Fax:309-734-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000429275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
14Z318Medicare ID - Type Unspecified