MEDICARE: DESIRED MEDICAL SERVICES 2 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1346000361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESIRED MEDICAL SERVICES 2 LLC

Provider Business Mailing Address
First Line	:	7820 N UNIVERSITY ST STE 110
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-8301
Country	:	US
Telephone Number	:	708-394-3296
Fax Number	:

Provider Business Practice Location Address
First Line	:	7820 N UNIVERSITY ST STE 110
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-8301
Country	:	US
Telephone Number	:	708-394-3296
Fax Number	:

Authorized Official
Title or Position	:	BILLING MGR
Name	:	MRS. KATRINA SMITH
Credential	:
Telephone Number	:	855-276-5212

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	03/19/2024

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Directions to “DESIRED MEDICAL SERVICES 2 LLC ” Practice Location

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