Healthcare Provider Details

I. General information

NPI: 1851776025
Provider Name (Legal Business Name): JOSEPH & HISHON INTEGRATED HEALTH CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 N UNIVERSITY ST SUITE A
PEORIA IL
61614-4799
US

IV. Provider business mailing address

5001 N UNIVERSITY ST SUITE A
PEORIA IL
61614-4799
US

V. Phone/Fax

Practice location:
  • Phone: 309-693-2225
  • Fax: 309-693-2228
Mailing address:
  • Phone: 309-693-2225
  • Fax: 309-693-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATH HISHON
Title or Position: OWNER
Credential:
Phone: 309-693-2225