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Contact Information

ILLINOIS VALLEY PODIATRY GROUP PC
3322 W WILLOW KNOLLS
PEORIA, IL61614
 Phone: 309-691-5800
 Fax: 309-691-1336
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Surgery, Foot

213ES0131X 48 Podiatry
 

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
Indicates primary specialty

NPI Profile & details for ILLINOIS VALLEY PODIATRY GROUP PC

NPI Number 1750506846
LBN Legal business name ILLINOIS VALLEY PODIATRY GROUP PC
Authorized official THOMAS BRATTAIN - (PODIATRIST)
Entity Organization
Organization subpart 1 No
Enumeration date 04/16/2007
Last updated 02/21/2013 - About 13 years ago
Identifiers
IL Other 0007215174 BLUE CROSS BLUE SHIELD
IL Other CM5560 RAILROAD MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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