Provider Demographics
NPI:1265432363
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 W HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-1007
Mailing Address - Country:US
Mailing Address - Phone:309-734-3141
Mailing Address - Fax:309-734-3029
Practice Address - Street 1:1000 W HARLEM AVE
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1007
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:2005-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010048251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health