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General NPI Number Information
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NPI Number | 1255721502
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Entity Type | Organization
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Legal Business Name | PEORIA HAND SURGERY, LLC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 107
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-693-3970
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Fax | 309-693-3971
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 107
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-693-3970
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Fax | 309-693-3971
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY J ADAMSON X
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Credential | M.D.
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Telephone | 309-693-3970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 036089935
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License Number State | IL
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