| Phoenix Wellness, Llc | |
|
2020 W War Memorial Dr Ste 304 Peoria IL 61614-6754 | |
| (309) 989-7282 | |
| Not Available |
| Full Name | Phoenix Wellness, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2020 W War Memorial Dr, Peoria, Illinois |
| Authorized Official Name and Position | Erin E Surratt (OWNER) |
| Authorized Official Contact | 3099897282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Wellness, Llc 105 Lexington Ct East Peoria IL 61611-5547 Ph: () - | Phoenix Wellness, Llc 2020 W War Memorial Dr Ste 304 Peoria IL 61614-6754 Ph: (309) 989-7282 |
| NPI Number | 1538608690 |
|---|---|
| Provider Enumeration Date | 02/21/2017 |
| Last Update Date | 02/21/2017 |
| Medicare PECOS PAC ID | 4183997679 |
|---|---|
| Medicare Enrollment ID | O20170905002415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538608690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149016007 (Illinois) | Primary |
| Provider Name | Erin E Surratt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558796789 PECOS PAC ID: 9335376763 Enrollment ID: I20131211000011 |
| Provider Name | Tammy Burtch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245748920 PECOS PAC ID: 7416217732 Enrollment ID: I20180207000069 |
| Provider Name | Angela Zumbek |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1598219594 PECOS PAC ID: 2567808660 Enrollment ID: I20240312001293 |
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