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General NPI Number Information
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NPI Number | 1104510650
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Entity Type | Organization
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Legal Business Name | VSR PLLC
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 180 W IMBODEN DR
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City | DECATUR
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State | IL
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Zip | 62521-5238
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Country | US
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Telephone | 715-207-1134
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 CONESTOGA DR STE 102 PO BOX 178
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City | SPRINGFIELD
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State | IL
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Zip | 62711-7937
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Country | US
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Telephone | 715-207-1134
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VENU M RANGU
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Credential | MD
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Telephone | 715-387-9055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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