| South Side Office Of Concern | |
|
202 Ne Madison Ave Peoria IL 61602-1285 | |
| (309) 674-7310 | |
| (309) 674-9652 |
| Full Name | South Side Office Of Concern |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 202 Ne Madison Ave, Peoria, Illinois |
| Authorized Official Name and Position | Christine Kahl (PRESIDENT /CEO) |
| Authorized Official Contact | 3092222560 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Side Office Of Concern 202 Ne Madison Ave Peoria IL 61602-1285 Ph: (309) 674-7310 | South Side Office Of Concern 202 Ne Madison Ave Peoria IL 61602-1285 Ph: (309) 674-7310 |
| NPI Number | 1528482148 |
|---|---|
| Provider Enumeration Date | 02/18/2014 |
| Last Update Date | 02/18/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528482148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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