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General NPI Number Information
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NPI Number | 1619376720
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Entity Type | Organization
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Legal Business Name | VISITING PHYSICIANS OF PEORIA INC
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 612 W JACKSON ST
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City | MORTON
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State | IL
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Zip | 61550-1536
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Country | US
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Telephone | 309-263-4787
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Fax | 309-263-4797
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Provider Business Mailing Address
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Address Line | 612 W JACKSON ST
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City | MORTON
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State | IL
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Zip | 61550-1536
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Country | US
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Telephone | 309-263-4787
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Fax | 309-263-4797
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Authorized Official
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Title or Position | IT/COORDINATOR
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Name | JUSTIN HOLLOWAY
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Credential |
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Telephone | 309-263-4787
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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 |
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License Number State |
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