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NPI Code Detail

MEDICARE: CENTRAL ILLINOIS NERVE TESTING LTD

MEDICARE: CENTRAL ILLINOIS NERVE TESTING LTD
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
1302F00000XExclusive Provider Organization016003701IL
2213EP1101XPrimary Podiatric Medicine Podiatrist016003701IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11114926748OTHERILCURTIS WARD, DPM
21093885378OTHERILMARK SMITH, DPM
31083613293OTHERILANTHONY V DECEANNE DPM
41285613463OTHERILT. KEVIN BRATTAIN, DPM

General Provider Information

NPI Number : 1386802775
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL ILLINOIS NERVE TESTING LTD
Provider Business Mailing Address
First Line : 614 SPRING ST
Second Line :
City : PEORIA
State : IL
Zip : 61603-4133
Country : US
Telephone Number : 309-637-3668
Fax Number : 309-637-2325
Provider Business Practice Location Address
First Line : 3322 W WILLOW KNOLLS RD
Second Line :
City : PEORIA
State : IL
Zip : 61614-8148
Country : US
Telephone Number : 309-691-1727
Fax Number : 309-637-2325
Authorized Official
Title or Position : DR
Name : DR. JOHN D RUFF
Credential : DPM
Telephone Number : 309-691-1727
Provider Enumeration Date : 06/02/2008
Last Update Date : 09/19/2008

Similar Medicare Providers

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1447659008 — MRS. MICHELLE L CARLSON LMT
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1437611720 — HANNAN ZAHID
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