Provider Demographics
NPI:1982789582
Name:ST. MARGARET'S HEALTH-PERU
Entity Type:Organization
Organization Name:ST. MARGARET'S HEALTH-PERU
Other - Org Name:IVCH IMMUNIZATION CLINIC
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 STREET
Mailing Address - Street 2:ILLINOIS VALLEY COMMUNITY HOSPITAL
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2799
Mailing Address - Country:US
Mailing Address - Phone:815-223-3300
Mailing Address - Fax:815-780-3781
Practice Address - Street 1:925 WEST STREET
Practice Address - Street 2:ILLINOIS VALLEY COMMUNITY HOSPITAL
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2799
Practice Address - Country:US
Practice Address - Phone:815-223-3300
Practice Address - Fax:815-780-3781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARGARET'S HEALTH-PERU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL212650282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212650OtherLEGACY PROVIDER NUMBER
IL212650Medicare PIN