Victoria J Brockhouse, DO | |
702 W Chestnut St, Bloomington, IL 61701-2814 | |
(309) 567-1400 | |
(309) 557-1461 |
Full Name | Victoria J Brockhouse |
---|---|
Gender | Female |
Speciality | Family Medicine |
Location | 702 W Chestnut St, Bloomington, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1790744555 | NPI | - | NPPES |
036081580 | Other | STATE LIC | |
833120 | Other | IL | MEDICARE GROUP |
036081580 | Medicaid | IL | |
080040113 | Other | IL | RR MEDICARE GROUP PTAN |
CA2264 | Other | RR MEDICARE GROUP PTAN | |
336043935 | Other | CONT SUBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 336.043935 (Illinois) | Primary |
207Q00000X | Family Medicine | 036081580 (Illinois) | Secondary |
Entity Name | Chestnut Health Systems, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1366431686 PECOS PAC ID: 1052393063 Enrollment ID: O20040603000738 |
Mailing Address | Practice Location Address |
---|---|
Victoria J Brockhouse, DO 2540 College And University, Normal, IL 61790-2540 Ph: (309) 438-2956 | Victoria J Brockhouse, DO 702 W Chestnut St, Bloomington, IL 61701-2814 Ph: (309) 567-1400 |
Dr. Justin James Holschbach, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 308 Saint Joseph Dr, Bloomington, IL 61701 Phone: 309-663-5050 Fax: 309-662-3401 | |
Jermy Enrique Crespo Gonzalez, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 2200 East Washington Street, Bloomington, IL 61701 Phone: 309-665-5996 | |
Stephen Belgrave, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 1701 E College Ave, Bloomington, IL 61704 Phone: 309-664-3170 | |
Daniel Marley, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1701 E College Ave, Bloomington, IL 61704 Phone: 309-664-3170 | |
Mfowethu Theophilus Langeni, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 210 Saint Joseph Dr, Bloomington, IL 61701 Phone: 309-663-5050 Fax: 309-662-3401 | |
Shilpa Mehta, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1505 Eastland Dr, Bloomington, IL 61701 Phone: 309-663-2100 Fax: 309-663-8322 | |
Kenneth Wayne Birge Jr., MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2502 E Empire St, Bloomington, IL 61704 Phone: 309-300-1031 |