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General NPI Number Information
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NPI Number | 1144931999
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Entity Type | Organization
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Legal Business Name | B3 HEALTHCARE PLLC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 319 E MADISON ST STE 2D
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City | SPRINGFIELD
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State | IL
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Zip | 62701-3120
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Country | US
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Telephone | 217-508-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 1404 ENGLISH OAK DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-3351
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Country | US
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Telephone | 217-273-3552
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLINTON HOLADAY
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Credential | MD
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Telephone | 217-508-5859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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