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General NPI Number Information
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NPI Number | 1598125031
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Entity Type | Organization
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Legal Business Name | PRIORITY HEALTH FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 5160 HICKORY POINT FRONTAGE RD
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City | DECATUR
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State | IL
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Zip | 62526-9778
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Country | US
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Telephone | 217-330-9788
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Fax | 217-330-8945
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Provider Business Mailing Address
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Address Line | 5160 HICKORY POINT FRONTAGE RD
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City | DECATUR
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State | IL
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Zip | 62526-9778
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Country | US
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Telephone | 217-330-9788
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Fax | 217-330-8945
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SHERYL L MILLER
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Credential |
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Telephone | 217-330-9788
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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 | 036107742
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036092026
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License Number State | IL
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