Provider Demographics
NPI:1861865370
Name:ST. MARGARET'S HEALTH-PERU
Entity Type:Organization
Organization Name:ST. MARGARET'S HEALTH-PERU
Other - Org Name:IVCH MEDICAL GROUP/ LASALLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:DORINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-780-3222
Mailing Address - Street 1:1305 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2759
Mailing Address - Country:US
Mailing Address - Phone:815-780-5030
Mailing Address - Fax:
Practice Address - Street 1:128 BUCKLIN ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-2389
Practice Address - Country:US
Practice Address - Phone:815-220-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARGARET'S HEALTH-PERU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-05
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL819300Medicare PIN