Healthcare Provider Details

I. General information

NPI: 1942722368
Provider Name (Legal Business Name): VISITING DOCTORS NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 W JACKSON ST
MORTON IL
61550-1536
US

IV. Provider business mailing address

618 W JACKSON ST
MORTON IL
61550-1536
US

V. Phone/Fax

Practice location:
  • Phone: 309-291-0479
  • Fax: 309-291-0932
Mailing address:
  • Phone: 309-291-0479
  • Fax: 309-291-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number036078962
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number036078962
License Number StateIL

VIII. Authorized Official

Name: ARACELI LEAR
Title or Position: OFFICE MANAGER
Credential: BSN RN MSHA
Phone: 309-291-0479