MEDICARE: DANVILLE HEALTHCARE, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	7002363	IL
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1558467936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANVILLE HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	26 W WEST NEWELL RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-7488
Country	:	US
Telephone Number	:	217-446-1400
Fax Number	:	217-446-5907

Provider Business Practice Location Address
First Line	:	26 W WEST NEWELL RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-7488
Country	:	US
Telephone Number	:	217-446-1400
Fax Number	:	217-446-5907

Authorized Official
Title or Position	:	BILLING/COLLECTIONS MANAGER
Name	:	MISS MARLA SUE CHRISTENSEN
Credential	:
Telephone Number	:	217-424-1021

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	10/14/2008

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Directions to “DANVILLE HEALTHCARE, LLC ” Practice Location

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