NPIMap

Organization Active NPI

Iroquois Memorial Hospital

Doing business as IMH General Surgery

  • Surgery Physician
  • Watseka, IL
National Provider Identifier
1083066674
Registry record updated Jul 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
IROQUOIS MEMORIAL HOSPITAL
Doing business as
IMH General Surgery
Practice address
200 E Fairman Ave
Watseka, IL 60970-1644
Phone
(815) 432-7966
NPI assigned
Jul 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erin Gwaltney
Title
Credentialing Specialist
Phone
(815) 432-7966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

200 E Fairman Ave
Watseka, IL 60970-1644

Mailing address

200 E Fairman Ave
Watseka, IL 60970-1644

Other names 1

  • IMH General Surgery Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Iroquois Memorial Hospi15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15486/brand/2/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467849600000",
    "number": "1083066674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E FAIRMAN AVE",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E FAIRMAN AVE",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701644",
            "telephone_number": "815-432-7966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IROQUOIS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-07",
        "last_updated": "2016-07-07",
        "status": "A",
        "authorized_official_last_name": "GWALTNEY",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "815-432-7966"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMH General Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watseka, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.