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OSF MULTISPECIALTY GROUP - EASTERN REGION LLC NPI 1487881058


NPI Information

NPI: 1487881058
Provider Name: OSF MULTISPECIALTY GROUP - EASTERN REGION, LLC

Doing Business As: OSF MEDICAL GROUP - COLLEGE AVENUE

Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 14D0664194

Address:
1701 E COLLEGE AVE
BLOOMINGTON, IL
ZIP 61704
Phone: (309) 664-3280
Get Directions

OSF MULTISPECIALTY GROUP - EASTERN REGION, LLC is an internal medicine in Bloomington, IL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. OSF MULTISPECIALTY GROUP - EASTERN REGION, LLC NPI is 1487881058. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Osf Medical Group - College Avenue.

The provider's business location address is:

1701 E COLLEGE AVE
BLOOMINGTON, IL
ZIP 61704-101
Phone: (309) 664-3280

The provider's authorized official is James M Moore .
The authorized official title is Ceo and has the following contact phone number (309) 655-2850.

The CLIA number assigned to this NPI record is 14D0664194 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/22/2009 and was last updated on 6/22/2009.


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
1207Y00000XOtolaryngologyNo
2207Q00000XFamily MedicineNo
3207T00000XNeurological SurgeryNo
42085R0202XRadiologyDiagnostic RadiologyNo
5208000000XPediatricsNo
6207V00000XObstetrics & GynecologyNo
7208C00000XColon & Rectal SurgeryNo
8207RP1001XInternal MedicinePulmonary DiseaseNo
92084P0800XPsychiatry & NeurologyPsychiatryNo
10208M00000XHospitalistNo
11208800000XUrologyNo
122083X0100XPreventive MedicineOccupational MedicineNo
13207X00000XOrthopaedic SurgeryNo
14103T00000XPsychologistNo
15207R00000XInternal MedicineYes

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
1PENDINGMEDICARE 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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.