Provider Demographics
NPI:1487978227
Name:MIDWEST MEDICAL CENTER
Entity type:Organization
Organization Name:MIDWEST MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHEAHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-776-7266
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-8118
Mailing Address - Country:US
Mailing Address - Phone:815-777-1340
Mailing Address - Fax:815-776-7274
Practice Address - Street 1:215 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-1635
Practice Address - Country:US
Practice Address - Phone:815-776-7255
Practice Address - Fax:815-776-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0049718314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362487178002Medicaid
IL362487178002Medicaid