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General NPI Number Information
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NPI Number | 1538101373
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Entity Type | Organization
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Legal Business Name | DANVILLE POLYCLINIC, LTD
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 707 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4360
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Country | US
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Telephone | 217-477-4794
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Fax | 217-477-4757
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Provider Business Mailing Address
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Address Line | 707 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4360
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Country | US
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Telephone | 217-477-4794
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Fax | 217-477-4757
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MELISSA A EDINGTON
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Credential |
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Telephone | 217-477-4794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7002371
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License Number State | IL
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