Healthcare Provider Details

I. General information

NPI: 1245275312
Provider Name (Legal Business Name): BELCREST SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E WAR MEMORIAL DR
PEORIA HEIGHTS IL
61616-7757
US

IV. Provider business mailing address

221 NE GLEN OAK AVE # GOMP100
PEORIA IL
61636-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-685-0100
  • Fax: 309-685-0172
Mailing address:
  • Phone: 309-672-4813
  • Fax: 309-671-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN M. CIRONE
Title or Position: MANAGER - REIMBURSEMENT RECOGNITION
Credential:
Phone: 309-672-4813