MEDICARE: VSR 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
1	208M00000X	Hospitalist Physician
2	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F100973628	OTHER	IL	MEDICARE PTAN

General Provider Information

NPI Number	:	1104510650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VSR PLLC

Provider Business Mailing Address
First Line	:	4200 CONESTOGA DR STE 102
Second Line	:	PO BOX 178
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7937
Country	:	US
Telephone Number	:	715-207-1134
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 W IMBODEN DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5238
Country	:	US
Telephone Number	:	715-207-1134
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VENU M RANGU
Credential	:	MD
Telephone Number	:	715-387-9055

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/20/2023

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Directions to “VSR PLLC ” Practice Location

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