PREMISE HEALTH OF ILLINOIS MEDICAL PC NPI 1295518868

NPI Information

NPI: 1295518868
Provider Name: PREMISE HEALTH OF ILLINOIS MEDICAL, PC

Doing Business As: MCL HEALTH CENTER - UTICA

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
740 E US HIGHWAY 6 STE B
UTICA, IL
ZIP 61373
Phone: (815) 310-5750
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PREMISE HEALTH OF ILLINOIS MEDICAL, PC is a multi-specialty clinic center in Utica, IL. PREMISE HEALTH OF ILLINOIS MEDICAL, PC NPI is 1295518868. The provider is registered as an organization entity type.
The provider Is Doing Business As Mcl Health Center - Utica.

The provider's business location address is:

740 E US HIGHWAY 6 STE B
UTICA, IL
ZIP 61373-755
Phone: (815) 310-5750
Fax: (815) 310-1051

The provider's authorized official is Will Wright .
The authorized official title is Legal Counsel and has the following contact phone number (615) 577-5893.

The CLIA number assigned to this NPI record is 14D2287978 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/16/2023 and was last updated on 2/7/2024.

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
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

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

NPI Synchronization or Removal

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