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General NPI Number Information
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NPI Number | 1588173454
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Entity Type | Organization
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Legal Business Name | THE OVAL CIRCLE LLC
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Dates
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Enumeration Date | 09/23/2017
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 411 N CLARENDON CT STE 104
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City | SAVOY
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State | IL
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Zip | 61874
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Country | US
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Telephone | 815-683-6109
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Fax | 888-665-3016
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Provider Business Mailing Address
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Address Line | 1408 ENGLISH OAK DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-3351
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Country | US
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Telephone | 217-766-5170
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CMO
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Name | DR. NITIN P BHOSALE
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Credential | MD
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Telephone | 815-683-6109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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