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General NPI Number Information
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NPI Number | 1720031602
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Entity Type | Organization
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Legal Business Name | TEVERBAUGH CROLAND & MUELLER OB/GYN & ASSOCIATES, S.C.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 8600 N. RT 91 #330
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City | PEORIA
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State | IL
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Zip | 61615
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Country | US
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Telephone | 309-692-2025
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Fax | 309-692-2446
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Provider Business Mailing Address
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Address Line | 8600 N. RT 91 SUITE 330
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City | PEORIA
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State | IL
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Zip | 61615
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Country | US
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Telephone | 309-692-2025
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Fax | 309-692-2446
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LORI A. TEVERBAUGH
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Credential | MD
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Telephone | 309-692-2025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036102227
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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