MEDICARE: DAVID G VERMILLION M D P C

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	208000000X	Pediatrics Physician	208000000X	IL
2	207R00000X	Internal Medicine Physician	207R00000X	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	370009963	OTHER	IL	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0003221864	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	019038	OTHER	IL	HEALTH ALLIANCE

General Provider Information

NPI Number	:	1154361921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID G VERMILLION M D P C

Provider Business Mailing Address
First Line	:	1802 N DIVISION ST STE 201
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-1183
Country	:	US
Telephone Number	:	815-513-5625
Fax Number	:	815-513-5624

Provider Business Practice Location Address
First Line	:	1802 N DIVISION ST STE 201
Second Line	:
City	:	MORRIS
State	:	IL
Zip	:	60450-1183
Country	:	US
Telephone Number	:	815-513-5625
Fax Number	:	815-513-5624

Authorized Official
Title or Position	:	BILLER/CODER
Name	:	MARY M. SMITH
Credential	:
Telephone Number	:	815-942-5200

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	12/18/2017

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Directions to “DAVID G VERMILLION M D P C ” Practice Location

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