| Visidoc, Llc | |
|
111 W Washington St Ste 310 East Peoria IL 61611-2559 | |
| (309) 699-4715 | |
| Not Available |
| Full Name | Visidoc, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 111 W Washington St Ste 310, East Peoria, Illinois |
| Authorized Official Name and Position | Karen Sedgwick (VICE PRESIDENT) |
| Authorized Official Contact | 3096994715 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Visidoc, Llc 111 W Washington St Ste 310 East Peoria IL 61611-2559 Ph: (309) 699-4715 | Visidoc, Llc 111 W Washington St Ste 310 East Peoria IL 61611-2559 Ph: (309) 699-4715 |
| NPI Number | 1932831427 |
|---|---|
| Provider Enumeration Date | 06/24/2022 |
| Last Update Date | 03/21/2024 |
| Medicare PECOS PAC ID | 7618315292 |
|---|---|
| Medicare Enrollment ID | O20240402000528 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932831427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Ryan D Schmidgall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548204779 PECOS PAC ID: 1456315977 Enrollment ID: I20060726000071 |
Proctor First Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2535 E Washington St, East Peoria, IL 61611 Phone: 309-694-6464 Fax: 309-694-6032 |