| Medical Service Plan @ Peoria | |
|
530 Ne Glen Oak Ave Dept Of Internal Medicine Peoria IL 61637-0001 | |
| (309) 655-3292 | |
| (309) 655-7732 |
| Full Name | Medical Service Plan @ Peoria |
|---|---|
| Speciality | Internal Medicine |
| Location | 530 Ne Glen Oak Ave, Peoria, Illinois |
| Authorized Official Name and Position | William R Nicholas (EX DIRECTOR OF MEDICAL SERVICE PLAN) |
| Authorized Official Contact | 3124130573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Service Plan @ Peoria 1 Illini Dr Peoria IL 61605-2576 Ph: (309) 671-8503 | Medical Service Plan @ Peoria 530 Ne Glen Oak Ave Dept Of Internal Medicine Peoria IL 61637-0001 Ph: (309) 655-3292 |
| NPI Number | 1255301909 |
|---|---|
| Provider Enumeration Date | 01/25/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255301909 | NPI | - | NPPES |
| 07215036 | Other | IL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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