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ILLINOIS VALLEY SPINE INSTITUTE LLC NPI 1336428192


NPI Information

NPI: 1336428192
Provider Name: ILLINOIS VALLEY SPINE INSTITUTE LLC
Classification: Orthopaedic Surgery - 207XS0117X
Entity Type: Organization

Specialization: Orthopaedic Surgery of the Spine

CLIA Number: 14D2079229

Address:
4231 PROGRESS BLVD
4
PERU, IL
ZIP 61354
Phone: (815) 780-8627
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ILLINOIS VALLEY SPINE INSTITUTE LLC is an orthopaedic surgery of the spine orthopaedic surgery in Peru, IL. The provider is recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive. ILLINOIS VALLEY SPINE INSTITUTE LLC NPI is 1336428192. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4231 PROGRESS BLVD
4
PERU, IL
ZIP 61354-193
Phone: (815) 780-8627
Fax: (815) 780-8630

The provider's authorized official is Jason Bergandi .
The authorized official title is Orthopaedic Surgeon and has the following contact phone number (815) 780-8627.

The CLIA number assigned to this NPI record is 14D2079229 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/11/2011 and was last updated on 11/28/2011.


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
1207XS0117XOrthopaedic SurgeryOrthopaedic Surgery of the Spine036-114114ILLINOISYes

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
1IL6014OTHERILLINOISMEDICARE
2036-114114MEDICAIDILLINOIS
3819300026MEDICARE PINILLINOIS

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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