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General NPI Number Information
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NPI Number | 1568426260
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Entity Type | Organization
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Legal Business Name | PEORIA DAY SURGERY CENTER LTD
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 7309 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-2085
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Country | US
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Telephone | 309-692-9210
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Fax | 309-683-4208
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Provider Business Mailing Address
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Address Line | 7309 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61614-2085
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Country | US
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Telephone | 309-692-9210
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Fax | 309-683-4208
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Authorized Official
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Title or Position | CEO
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Name | DR. JUSTIN R AHLMAN
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Credential | M.D.
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Telephone | 309-692-9210
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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 | 7001449
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License Number State | IL
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