Healthcare Provider Details

I. General information

NPI: 1508867557
Provider Name (Legal Business Name): EAGLE FAMILY MEDICINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E KNOXVILLE ST
BRIMFIELD IL
61517-8022
US

IV. Provider business mailing address

111 E KNOXVILLE ST
BRIMFIELD IL
61517-8022
US

V. Phone/Fax

Practice location:
  • Phone: 309-446-3305
  • Fax: 309-446-9072
Mailing address:
  • Phone: 309-446-3305
  • Fax: 309-446-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT SCOTT BEVILL
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 309-446-3305