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NPI Code Detail

MEDICARE: CENTRAL ILLINOIS SNF CARE PLLC

MEDICARE: CENTRAL ILLINOIS SNF CARE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist Physician
2207R00000XInternal Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F100967946OTHERILMEDICARE GROUP PTAN

General Provider Information

NPI Number : 1063103190
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL ILLINOIS SNF CARE PLLC
Provider Business Mailing Address
First Line : 1517 W WALNUT ST
Second Line :
City : JACKSONVILLE
State : IL
Zip : 62650-1133
Country : US
Telephone Number : 630-336-5620
Fax Number :
Provider Business Practice Location Address
First Line : 1517 W WALNUT ST
Second Line :
City : JACKSONVILLE
State : IL
Zip : 62650-1133
Country : US
Telephone Number : 630-336-5620
Fax Number :
Authorized Official
Title or Position : PRESIDENT / OWNER
Name : BHAVIN VALLABHBHAI SONANI
Credential :
Telephone Number : 630-336-5620
Provider Enumeration Date : 05/18/2023
Last Update Date : 10/03/2023

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Directions to “CENTRAL ILLINOIS SNF CARE PLLC ” Practice Location

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