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General NPI Number Information
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NPI Number | 1063823557
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Entity Type | Organization
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Legal Business Name | BEAUMONT SMALL ANIMAL CLINIC
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 1304 N CUNNINGHAM AVE
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City | URBANA
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State | IL
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Zip | 61802-1817
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Country | US
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Telephone | 217-367-1187
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 N CUNNINGHAM AVE
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City | URBANA
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State | IL
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Zip | 61802-1817
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Country | US
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Telephone | 217-367-1187
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Fax |
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Authorized Official
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Title or Position | VETERINARIAN
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Name | DR. TRACI LYN GILBERT
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Credential | DVM
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Telephone | 217-367-1187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 090.010924
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License Number State | IL
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