Healthcare Provider Details

I. General information

NPI: 1548376353
Provider Name (Legal Business Name): VIRGINIA PRICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER DR ANESTHESIOLOGY DEPARTMENT
MATTOON IL
61938-9253
US

IV. Provider business mailing address

1000 HEALTH CENTER DR ANESTHESIOLOGY DEPARTMENT
MATTOON IL
61938-9253
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-2440
  • Fax:
Mailing address:
  • Phone: 217-258-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-110088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: