Provider Demographics
NPI: | 1730788902 |
---|---|
Name: | OSF HEALTHCARE SYSTEM |
Entity type: | Organization |
Organization Name: | OSF HEALTHCARE SYSTEM |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | SEHRING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 309-655-2850 |
Mailing Address - Street 1: | 124 SW ADAMS ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PEORIA |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 61602-1308 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 309-655-2850 |
Mailing Address - Fax: | 309-655-4878 |
Practice Address - Street 1: | 235 E PENN AVE |
Practice Address - Street 2: | |
Practice Address - City: | ROSEVILLE |
Practice Address - State: | IL |
Practice Address - Zip Code: | 61473-5006 |
Practice Address - Country: | US |
Practice Address - Phone: | 309-426-2128 |
Practice Address - Fax: | 309-426-2455 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-10-20 |
Last Update Date: | 2024-03-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 999 | Medicaid |