Healthcare Provider Details

I. General information

NPI: 1801907290
Provider Name (Legal Business Name): NEONATOLOGY ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

PO BOX 1186
PEKIN IL
61555-1186
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-2485
  • Fax: 309-655-2974
Mailing address:
  • Phone: 309-353-4483
  • Fax: 309-353-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES R HOCKER
Title or Position: PRESIDENT
Credential: MD
Phone: 309-353-4483