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General NPI Number Information
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NPI Number | 1801061650
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Entity Type | Organization
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Legal Business Name | CENTER FOR PAIN MANAGEMENT & REHAB S. C .
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 117
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City | PEORIA
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State | IL
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Zip | 61614-5095
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Country | US
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Telephone | 309-689-8888
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Fax | 309-689-8410
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 117
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City | PEORIA
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State | IL
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Zip | 61614-5095
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Country | US
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Telephone | 309-689-8888
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Fax | 309-689-8410
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YIBING LI
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Credential | MD
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Telephone | 309-696-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 036113585
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 036113585
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License Number State | IL
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