NPIMap

Organization Active NPI

Methodist Medical Center of Illinois

  • Clinical Medical Laboratory
  • Peoria, IL
National Provider Identifier
1366031452
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
METHODIST MEDICAL CENTER OF ILLINOIS
Practice address
221 NE Glen Oak Ave
Peoria, IL 61636-0002
Phone
(309) 672-4911
NPI assigned
Jan 13, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Authorized official

Name
Dr. Keith Knepp, M.D.
Title
Ceo
Phone
(309) 671-2528

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

221 NE Glen Oak Ave
Peoria, IL 61636-0002

Mailing address

221 NE Glen Oak Ave
Peoria, IL 61636-0002
Phone (309) 672-4911

National Provider Directory

National Provider Directory
Tax ID family
Methodist Medical Cente9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1366031452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616360002",
            "telephone_number": "309-672-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616360002",
            "telephone_number": "309-672-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST MEDICAL CENTER OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "KNEPP",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-671-2528",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; 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.