| Medical Service Plan At Peoria | |
|
Department Of Psychiatry 221 Ne Glen Oak 7 West Peoria IL 61636-0001 | |
| (309) 671-8222 | |
| Not Available |
| Full Name | Medical Service Plan At Peoria |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | Department Of Psychiatry, Peoria, Illinois |
| Authorized Official Name and Position | William R Nicholas (EXECUTIVE DIRECTOR OF MSP) |
| Authorized Official Contact | 3124130573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Service Plan At Peoria 1 Illini Dr Peoria IL 61605-2576 Ph: (309) 671-8503 | Medical Service Plan At Peoria Department Of Psychiatry 221 Ne Glen Oak 7 West Peoria IL 61636-0001 Ph: (309) 671-8222 |
| NPI Number | 1245203280 |
|---|---|
| Provider Enumeration Date | 02/09/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245203280 | NPI | - | NPPES |
| 07215036 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Illinois) | Primary |
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