| Central Illinois Center For Wellness, Llc | |
|
2501 E College Ave Ste C Bloomington IL 61704-2484 | |
| (309) 807-5356 | |
| (309) 807-5291 |
| Full Name | Central Illinois Center For Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2501 E College Ave Ste C, Bloomington, Illinois |
| Authorized Official Name and Position | William John Ray (PHYSICIAN/OWNER) |
| Authorized Official Contact | 3098075356 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Illinois Center For Wellness, Llc 2501 E College Ave Ste C Bloomington IL 61704-2484 Ph: (309) 807-5356 | Central Illinois Center For Wellness, Llc 2501 E College Ave Ste C Bloomington IL 61704-2484 Ph: (309) 807-5356 |
| NPI Number | 1104391739 |
|---|---|
| Provider Enumeration Date | 10/10/2018 |
| Last Update Date | 08/01/2024 |
| Medicare PECOS PAC ID | 0042564916 |
|---|---|
| Medicare Enrollment ID | O20181112001887 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104391739 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | William J Ray |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689672859 PECOS PAC ID: 2567455041 Enrollment ID: I20040628000247 |
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