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PROVENA SERVICE CORPORATION NPI 1255526687


NPI Information

NPI: 1255526687
Provider Name: PROVENA SERVICE CORPORATION

Doing Business As: PROVENA MEDICAL GROUP

Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
102 N LOGAN AVE
DANVILLE, IL
ZIP 61832
Phone: (217) 442-5863
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PROVENA SERVICE CORPORATION is a pediatrics in Danville, IL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PROVENA SERVICE CORPORATION NPI is 1255526687. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Provena Medical Group.

The provider's business location address is:

102 N LOGAN AVE
DANVILLE, IL
ZIP 61832-513
Phone: (217) 442-5863
Fax: (217) 442-5040

The provider's authorized official is Daniel Boland .
The authorized official title is Financial Reporting Manager and has the following contact phone number (815) 806-3111.

The enumeration date for this NPI number is 9/10/2007 and was last updated on 4/20/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1=========003MEDICAIDILLINOIS
2148931MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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