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General NPI Number Information
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NPI Number | 1902059215
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Entity Type | Organization
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Legal Business Name | MEMORIAL HEALTH VENTURES
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 100 CHATHAM RD
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City | SPRINGFIELD
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State | IL
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Zip | 62704-1533
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Country | US
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Telephone | 217-862-0444
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Fax | 217-546-3584
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Provider Business Mailing Address
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Address Line | PO BOX 3428
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City | SPRINGFIELD
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State | IL
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Zip | 62708-3428
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Country | US
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Telephone | 800-577-5368
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Fax | 217-757-2021
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Authorized Official
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Title or Position | VICE PRESIDENT, BUSINESS DEVELOPMEN
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Name | KEVIN ENGLAND
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Credential |
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Telephone | 217-788-3851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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