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General NPI Number Information
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NPI Number | 1326850587
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Entity Type | Organization
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Legal Business Name | CENTRAL ILLINOIS PREVENTIVE SERVICES LLC
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 5359 EASTERN AVE
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City | DAVENPORT
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State | IA
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Zip | 52807-2738
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Country | US
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Telephone | 563-306-2660
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Fax |
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Provider Business Mailing Address
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Address Line | 2426 W CORNERSTONE CT STE 100
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City | PEORIA
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State | IL
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Zip | 61614-2400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JESSICA STEWART
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Credential |
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Telephone | 309-267-2719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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