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General NPI Number Information
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NPI Number | 1386802775
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Entity Type | Organization
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Legal Business Name | CENTRAL ILLINOIS NERVE TESTING LTD
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 3322 W WILLOW KNOLLS RD
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City | PEORIA
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State | IL
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Zip | 61614-8148
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Country | US
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Telephone | 309-691-1727
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Fax | 309-637-2325
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Provider Business Mailing Address
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Address Line | 614 SPRING ST
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City | PEORIA
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State | IL
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Zip | 61603-4133
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Country | US
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Telephone | 309-637-3668
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Fax | 309-637-2325
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Authorized Official
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Title or Position | DR
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Name | DR. JOHN D RUFF
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Credential | DPM
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Telephone | 309-691-1727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 016003701
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 016003701
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License Number State | IL
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